Effect of Covid‐19 pandemic process on STEMI patients timeline

Soylu, Korhan; Çoksevim, Metin; Yanık, Ahmet; Çerik, İdris Buğra; Aksan, Gökhan

doi:10.1111/ijcp.14005

Cited by 13 publications

(14 citation statements)

References 24 publications

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“…A total of 32 studies met our inclusion criteria. Four studies each originated from China, 4,24,32,33 Italy, 20,[34][35][36] and North America, [37][38][39][40] 3 each from France [41][42][43] and Turkey, [44][45][46] 2 from the United Kingdom, 47,48 and 1 each from Austria, 49 Belgium, 50 Egypt, 51 Iran, 52 Israel, 53 Japan, 54 Pakistan, 55 Poland, 56 Singapore, 23 Spain, 57 and Switzerland. 60 One study was a multicentred cohort study of various databases belonging to different European countries.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Chew

Teo

et al. 2021

Canadian Journal of Cardiology

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Background The coronavirus disease-2019 (COVID-19) pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. This review examines the global impact of COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door-to-balloon time (D2B), all-cause mortality and other secondary STEMI outcomes. Methods We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies comparing the aforementioned outcomes between STEMI patients during and before the pandemic. Results In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic respectively. Significant delay in D2B was observed during the pandemic (WMD=8.10mins; CI:3.90-12.30mins; p =0.0002, I 2 =90%). In-hospital mortality was higher during the pandemic (OR=1.27; CI:1.09-1.49; p= 0.002, I 2 =36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis found that low-middle income countries observed a higher rate of mortality during the pandemic (OR=1.52; CI:1.13-2.05; p =0.006), with a similar but insignificant trend seen among the high income countries (OR=1.17; CI:0.95-1.44; p =0.13). Conclusion The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.

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Section: Summary Of Included Studiesmentioning

confidence: 99%

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Chew

Teo

et al. 2021

Canadian Journal of Cardiology

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“…Additionally, 56 records were excluded based on several reasons: 1) outcomes of interest were not relevant ( n = 31); 2) a comparison between two period was not reported ( n = 16); 3) articles were case report/series ( n = 9). Eventually, a total of 35 studies with 62,247 participants 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 were evaluated in our meta-analysis. STEMI patients who presented in the pandemic period were older, predominately from male population, had a higher prevalence of comorbid conditions, and had worse cardiac function during hospital admission.…”

Section: Resultsmentioning

confidence: 99%

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

Kamarullah¹,

Sabrina²,

Rocky³

et al. 2021

Indian Heart Journal

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Introduction There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter. Methods We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak. Results Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak ( n = 10,263) in contrast to before the outbreak period ( n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups. Conclusion There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.

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“…The fact that the area of absolute infarction is minimal to nil depending on the time from occlusion to reperfusion explains why the incidence has plummeted. Delayed presentations during the pandemic, and delayed interventions due to ever-changing protocols to keep patients and healthcare workers safe, may have contributed to a surge in post-MI complications, as seen in our patient [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Change in healthcare-seeking behavior seems to have arisen from contamination obsession (a form of obsessive-compulsive disorder focused on hand-washing) exacerbated by the pandemic, worry of being a burden on the healthcare system due to widespread media coverage of an overstretched medical system, and a decrease in EMS workers [ 5 , 6 ]. A direct association between the increased number of COVID-19 infections and a substantial decrease in STEMI undergoing percutaneous coronary interventions (PCI) and a significantly longer door-to-balloon time was noticed [ 3 ]. This appears to be due to strict containment measures leading to stringent screening and use of conservative management in select patients considered high risk for COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

“…Overall STEMI incidences appear to have dropped during the lockdown period due to decrease in environmental exposures [ 2 ]. In spite of that, there may be a rise in post-MI complications due to changing patient behavior and changed in-hospital management of STEMI, especially in the early phase of the pandemic [ 2 , 3 ]. This has led to some places observing a higher troponin level at the time of admission, increased in-hospital complications, and lower left ventricular ejection fraction on admission [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Delayed Presentation During COVID-19 Pandemic Leading to Post-Myocardial Infarction Ventricular Septal Defect

Gadre¹,

Kotaru²,

Mehta³

et al. 2021

Cureus

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Post-myocardial infarction ventricular septal defect (post-MI VSD) is a rare complication of ST-elevation myocardial infarction (STEMI) with an incidence of <1% in early revascularization era. Here we present the case of a 66-year-old woman with post-MI VSD owing to delay in her presentation in the current pandemic. Patient presented with worsening back pain and chest pain with confusion, and an EKG positive for inferior wall STEMI. She underwent emergent percutaneous intervention with placement of drug-eluting stent in her right coronary artery. She developed worsening heart failure and new-onset heart murmur and was found to have a VSD on a transthoracic echo. Because of her poor prognosis, family decided to pursue comfort care and patient unfortunately passed. Delay in seeking health care during the pandemic, as seen in our patient, is multifactorial including fear of contracting infection, decreased emergency medical services members, and concerns for overburdening healthcare systems. Lack of standardized in-hospital approach to emergencies while ensuring adequate protection from infection to healthcare workers, especially during the initial phase of the pandemic, led to increased door-to-balloon times in addition to the increased time to first medical contact. The importance of media outreach ensuring availability of health care in emergencies, changing emergency response algorithms to ensure safety of patients and healthcare providers, and including thrombolytic therapy where there is a delay due to stringent screening or delayed COVID-19 testing can be used to prevent worsening complications following STEMI.

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Effect of Covid‐19 pandemic process on STEMI patients timeline

Cited by 13 publications

References 24 publications

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

Delayed Presentation During COVID-19 Pandemic Leading to Post-Myocardial Infarction Ventricular Septal Defect

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