Background: Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have affected management of STEMI. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system. Methods: Four hundred ninety-four patients with STEMI were grouped into prelockdown, lockdown, and reopening cohorts. Clinical, temporal, and outcome data were collected and compared among groups for R ESUM EContexte : La prise en charge de l'infarctus du myocarde avec el evation du segment ST (STEMI) n ecessite une reperfusion rapide. Tout retard de reperfusion prolonge l'isch emie myocardique et augmente le risque de complications, y compris le risque de d ecès. Il est possible que la pand emie de COVID-19 ait nui à la prise en charge du STEMI. Nous avons donc evalu e le nombre relatif d'hospitalisations et le temps ecoul e avant la reperfusion au sein d'un système r egional de traitement des STEMI. M ethodologie : Au total, 494 patients ayant pr esent e un STEMI ont et e divis es en trois cohortes : pr econfinement, confinement et During the COVID-19 pandemic, a reduction in patients presenting with ST-elevated myocardial infarction (STEMI) has been reported. 1,2 These studies lacked data on important areas including impact of the COVID-19 lockdown on STEMI care in regions with low incidence of disease, granular details regarding reperfusion management during lockdown, effect of the pandemic on STEMI care in rural regions, and patterns of STEMI volume posteCOVID-19 lockdown. It is imperative to study the effects of COVID-19 comprehensively, so that lessons can be learned for a potential second wave or future pandemics.From March 11, 2020, to August 16, 2020, the Ottawa regions recorded 2761 cases of In response to the initial outbreak, the Ontario Ministry of Health declared a state of emergency and instituted lockdown measures on March 17, 2020. 4 Various restrictions were imposed including closure of nonessential businesses, limits on social gatherings, and cancellation of elective medical procedures. 4 These interventions were successful in limiting the spread of COVID-19; however, concerns regarding an unintended impact on STEMI care were raised. 3,

Aims The PRECISE-DAPT score identifies patients at high risk of bleeding complications following percutaneous coronary intervention (PCI). International guidelines recommend the PRECISE-DAPT to identify patients at high risk for bleeding, who may benefit from shortened dual antiplatelet therapy (DAPT). The association of the PRECISE-DAPT score to ischemic outcomes remains unclear. We performed a meta-analysis investigating the association between a high PRECISE-DAPT score and ischemic outcomes. Methods and Results A comprehensive literature search was conducted on articles published between March 11, 2017 and June 5, 2021. Two reviewers independently screened articles for inclusion using pre-defined criteria. Outcome measures extracted included: composite ischemic events, major bleeding events and all-cause mortality. A random effects model was applied to obtain combined risk estimates for outcomes. From 12 included studies, there were 39459 patients with PRECISE-DAPT <25 and 14761 patients with PRECISE-DAPT ≥ 25. PRECISE-DAPT score ≥ 25 was associated with increased risk of composite ischemic events [OR 2.16; 95% CI 1.77-2.65], myocardial infarction [OR 2.06; 95% CI 1.38-3.08] and ischemic stroke [OR 2.90; 95% CI 1.76-4.78]. Patients with a PRECISE-DAPT score ≥ 25 had increased risk of major bleeding [OR 3.62; 95% CI 2.62-4.99]. Patients with a PRECISE-DAPT score ≥ 25 had higher risk of all-cause mortality [OR 5.83; 95% CI 5.37-6.33]. Conclusion Patients with a PRECISE-DAPT score ≥ 25 are at increased risk for ischemic events, bleeding, and all-cause mortality. Prospective evaluation of a PRECISE-DAPT guided antiplatelet therapy approach is required to demonstrate benefit in this high-risk population.

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