“Back to the Future” for STEMI?

Riley, Robert F.; Kereiakes, Dean J.; Mahmud, Ehtisham; Smith, Timothy D.; Grines, Cindy L.; Henry, Timothy D.

doi:10.1016/j.jaccas.2020.07.011

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…21,22 There were remarkable reductions in STEMI activations worldwide with substantial decrease in use of coronary angiography and PCI, longer door-toballoon and total ischemic times, and increased risk of mechanical complications. [21][22][23][24][25][26] In parallel, we observed a remarkable increase in In parallel with previous observations, 10,11 we found that late presenters were more likely to be older, female, and have a high cardiovascular risk profile. It is likely that atypical ischemic symptoms, known to be common in these patients, may delay seeking care.…”

Section: Methodssupporting

confidence: 87%

“…National and local actions to mitigate the pandemic, such as lockdown restrictions, social isolation with substantial fear of infection, and deferral of routine health care, subsequently resulted in unintended consequences in STEMI care 21,22 . There were remarkable reductions in STEMI activations worldwide with substantial decrease in use of coronary angiography and PCI, longer door‐to‐balloon and total ischemic times, and increased risk of mechanical complications 21–26 . In parallel, we observed a remarkable increase in late presenters (almost doubled) during the early phase of the Covid‐19 pandemic in 2020.…”

Section: Discussionmentioning

confidence: 74%

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Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Griffin

Yıldız

Bradley

et al. 2022

Cathet Cardio Intervent

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Objectives To assess the characteristics and prognosis of ST‐elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. Background Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late‐presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. Methods Using a two‐center registry‐based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3−6, 6−12, and 12−24 h (late presenters). Results Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid‐19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door‐to‐balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In‐hospital and 1‐year death risks were comparable between late and earlier presenters. Conclusion Despite the unfavorable risk profile and longer door‐to‐balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

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Section: Methodssupporting

confidence: 87%

Section: Discussionmentioning

confidence: 74%

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Griffin

Yıldız

Bradley

et al. 2022

Cathet Cardio Intervent

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“…Another important limitation is the lack of pre-hospital data regarding total ischemic and transfer times for patients presenting to a non-PPCI hospital. Late STEMI presentations have been reported during the pandemic ( 19 , 20 ). In many patients, D2B time could not be accurately estimated because of atypical presentations (i.e., dyspnea instead of chest pain) that could not be timed to STEMI onset per se in the setting of COVID 19 infection.…”

Section: Discussionmentioning

confidence: 99%

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

García¹,

Dehghani²,

Grines³

et al. 2021

Journal of the American College of Cardiology

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111

157

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Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). Conclusions COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.

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“…Since the mortality of untreated MI approximates 30–40% [ 16 ] and as 70% of the French territory was, similar to “Pays-de-la-Loire” province, relatively spared by COVID-19 (Supplemental figure), the observation that the number of missing MIs represented nearly 40% of the COVID-related deaths in that province may raise fears of a very heavy nationwide MI-related death toll. Further studies will be needed to detect a potential resurgence of mechanical complications or heart failure [ 17 , 18 ] and increase of cardio-vascular mortality as a consequence of COVID-19 outbreak-related lockdown.…”

Section: Discussionmentioning

confidence: 99%

Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Belle¹,

Manigold²,

Piérache³

et al. 2021

The Lancet Regional Health - Europe

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Background A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided. Methods To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern “Hauts-de-France” province and western “Pays-de-la-Loire” Province. The incidence of COVID-19 fatalities was also collected. Findings In “Hauts-de-France”, during lockdown (March 18–May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71–0.84, p <0.001) was observed for a loss of 272 MIs (95%CI:−363,−181), representing 18% of COVID-19-related deaths. In “Pays-de-la-Loire”, 382 COVID-19-related deaths were observed. A 19% decrease in MI-IR (IRR=0.81; 95%CI=0.73–0.90, p <0.001) was observed for a loss of 138 MIs (95%CI:−210,−66), representing 36% of COVID-19-related deaths. While in “Hauts-de-France” the MI decline started before lockdown and recovered 3 weeks before its end, in “Pays-de-la-Loire”, it started after lockdown and recovered only by its end. In-hospital mortality of MI patients was increased during lockdown in both provinces (5.0% vs 3.4%, p =0.02). Interpretation It highlights one of the potential collateral damages of COVID-19 outbreak on cardiovascular health with a dramatic reduction of MI incidence. It advocates for a careful and weighted communication strategy in pandemic crises. Funding The study was conducted without external funding.

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“Back to the Future” for STEMI?

Abstract: Central Illustration

Cited by 9 publications

References 16 publications

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

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