Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic

Abstract

The situation around primary percutaneous coronary intervention (PCI) has dramatically changed since coronavirus disease 2019 (COVID-19) pandemic. The impact of COVID-19 pandemic on clinical outcomes as well as door-to-balloon time (DTBT), which is known as one of the indicators of early reperfusion, has not been fully investigated in patients with ST-elevation acute myocardial infarction (STEMI). The purpose of this study was to compare DTBT and in-hospital outcomes in patients with STEMI between before versus after COVID-19 pandemic. The primary interest was DTBT and the incidence of in-hospital outcomes including in-hospital death. We included 330 patients with STEMI who underwent primary PCI, and divided them into the pre COVID-19 group ( n = 209) and the post COVID-19 group ( n = 121). DTBT was significantly longer in the post COVID-19 group than in the pre COVID-19 group ( p < 0.001), whereas the incidence of in-hospital death was comparable between the 2 groups ( p = 0.238). In the multivariate logistic regression analysis, chest CT before primary PCI (OR 4.64, 95% CI 2.58–8.34, p < 0.001) was significantly associated with long DTBT, whereas chest CT before primary PCI (OR 0.76, 95% CI 0.29–1.97, p = 0.570) was not associated with in-hospital death after controlling confounding factors. In conclusion, although DTBT was significantly longer after COVID-19 pandemic than before COVID-19 pandemic, in-hospital outcomes were comparable between before versus after COVID-19 pandemic. This study suggests the validity of the screening tests including chest CT for COVID-19 in patients with STEMI who undergo primary PCI.

Impact of the COVID-19 pandemic on the hospitalizations, time course, presenting symptoms, and mid-term outcomes in patients with myocardial infarctions in a Japanese multi-center registry

“…In the present study, the DTBT was significantly longer and 180-day mortality numerically (but not significantly) greater in the after-pandemic period than the pre-pandemic period, which was consistent with the previous Japanese reports [ 3 – 5 ]. On the other hand, the results outside of Japan have shown an increase in the mortality from AMIs in the after-pandemic period [ 18 – 20 ].…”

“…Several studies from Japan have reported a significantly longer time of the door-to-balloon time (DTBT), while the short-term mortality has been preserved after the COVID-19 pandemic as compared to that before the pandemic in patients with ST-elevation myocardial infarctions (STEMIs) [ 3 – 5 ]. As for the patients with non-ST-elevation myocardial infarctions (NSTEMIs), there are few Japanese data focusing on investigating the impact of the COVID-19 pandemic.…”

Treatment delay and outcomes of ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention during the COVID-19 era in South Korea

“…It remains unclear why AMI workflow was significantly disrupted with prolonged S2DT and D2BT in the COVID-19 group. Through literature review, we identified many studies with findings in line with our study results (prolongation of pre-hospital and in-hospital delay) [15,17,23]. Although not specified in the data of the present study, the EMS pro- cess time may be prolonged during the COVID-19 pandemic era because of safety precautions and changes in basic preparatory procedure [9,24,25].…”

“…Nevertheless, little is known about the clinical characteristics and treatment outcomes of ST-segment elevation myocardial infarction (STEMI), which requires timely and rapid percutaneous coronary intervention (PCI), in South Korea between pre-COVID-19 and COVID-19 periods. In particular, the treatment delay for STEMI was expected in the COVID-19 era, and this has been supported by clinical evidence in several studies [15][16][17]. Therefore, we aimed to analyze the differences in the clinical characteristics and treatment outcomes before and after the COVID-19 era in patients with STEMI in South Korea.…”

Changes in Acute Myocardial Infarction, Stroke, and Heart Failure Hospitalizations During COVID-19 Pandemic in Tuscany—An Interrupted Time Series Study

“…Studies from Emilia-Romagna [ 57 ] and Lombardia [ 43 ] have found an increase in out-of-hospital mortality due to cardiac causes in the first wave of the pandemic. While Tuscany was relatively less affected by COVID-19 compared to other regions in Italy, complementary studies that examine cardiac conditions care pathway process measures such as door-to-balloon time [ 58 ] can better elucidate interpretations. For example, Rossi and colleagues found that in-hospital mortality rates for AMI patients did not change significantly after COVID-19 in Brescia despite an increase in door-to-balloon time, pointing towards a threshold of care management of keeping this measure to 95 min for AMI patients [ 59 ].…”