Aims To assess the impact of the lockdown due to coronavirus disease 2019 (COVID-19) on key quality indicators for the treatment of ST-segment elevation myocardial infarction (STEMI) patients. Methods Data were obtained from 41 hospitals participating in the prospective Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) study, including 15,800 patients treated for acute STEMI from January 2017 to the end of March 2020. Results There was a 12.6% decrease in the total number of STEMI patients treated at the peak of the pandemic in March 2020 as compared to the mean number treated in the March months of the preceding years. This was accompanied by a significant difference among the modes of admission to hospitals ( p = 0.017) with a particular decline in intra-hospital infarctions and transfer patients from other hospitals, while the proportion of patients transported by emergency medical service (EMS) remained stable. In EMS-transported patients, predefined quality indicators, such as percentages of pre-hospital ECGs (both 97%, 95% CI = − 2.2–2.7, p = 0.846), direct transports from the scene to the catheterization laboratory bypassing the emergency department (68% vs. 66%, 95% CI = − 4.9–7.9, p = 0.641), and contact-to-balloon-times of less than or equal to 90 min (58.3% vs. 57.8%, 95%CI = − 6.2–7.2, p = 0.879) were not significantly altered during the COVID-19 crisis, as was in-hospital mortality (9.2% vs. 8.5%, 95% CI = − 3.2–4.5, p = 0.739). Conclusions Clinically important indicators for STEMI management were unaffected at the peak of COVID-19, suggesting that the pre-existing logistic structure in the regional STEMI networks preserved high-quality standards even when challenged by a threatening pandemic. Clinical trial registration NCT00794001 Electronic supplementary material The online version of this article (10.1007/s00392-020-01703-z) contains supplementary material, which is available to authorized users.

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SUMMARYThis paper investigates two approaches for the handling of hanging nodes in the framework of extended finite element methods (XFEM). Allowing for hanging nodes, locally refined meshes may be easily generated to improve the resolution of general, i.e. model-independent, steep gradients in the problem under consideration. Hence, a combination of these meshes with XFEM facilitates an appropriate modeling of jumps and kinks within elements that interact with steep gradients. Examples for such an interaction are, e.g. found in stress fields near crack fronts or in boundary layers near internal interfaces between two fluids. The two approaches for XFEM based on locally refined meshes with hanging nodes basically differ in whether (enriched) degrees of freedom are associated with the hanging nodes. Both approaches are applied to problems in linear elasticity and incompressible flows.

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