Impact of COVID-19 on Acute MI and Percutaneous Coronary Intervention Rates and Outcomes in South East Asia and the Middle East

Abstract

Background: Previous studies have reported mixed findings regarding the effects of COVID-19 on percutaneous coronary intervention (PCI) and acute MI (AMI) procedural volumes and case fatalities, as well as on ST-elevation MI (STEMI) door-to-balloon time (DTB). This study characterised the effects of COVID-19 on AMI and PCI volumes and mortality outcomes in countries from Asia and the Middle East, which faced repeated waves of COVID-19. Methods: Pooled data on AMI and PCI case volumes were collected in 4-weekly blocks from Malaysia, Singapore and Abu Dhabi from 2019 (pre-COVID-19) and 2020 (during COVID-19). These were compared against reported COVID-19 case numbers. Case fatality rates, STEMI patient demographics and STEMI DTB times were compared between the pre- and during COVID-19 periods. Results: During the COVID-19 pandemic, there was a comparative reduction in non-STEMI (NSTEMI) cases in Singapore (from 814 to 722; p=0.025) and Malaysia (from 925 to 604; p<0.001), but not in Abu Dhabi (from 144 to 188; p=0.010). PCI volumes fell significantly in Singapore (from 13,089 to 11,449; p=0.020), but not in Malaysia or Abu Dhabi. STEMI volume remained similar before and during COVID-19. There were no significant differences in in-hospital mortality for NSTEMI, STEMI or PCI between the two periods. Conclusion: COVID-19 resulted in a fall in NSTEMI and PCI cases, potentially as a result of patients deferring contact with healthcare institutions. With appropriate protocols and systems, it is possible to provide coronary intervention services in the middle of a pandemic without compromising on mortality or DTB outcomes.

Statistical findings and outcomes of acute coronary syndrome patients during COVID-19 pandemic: A cross sectional study

“…Similar reductions were shown by Mafham et al (40%) and Spaccarotella et al (48%). [9] , [14] This is considered a huge decrease compared to a study by Tern et al in Malaysia (23%), Singapore (20%) [15] and Clifford et al (20%). [16] These data consistent with meta-analysis by Sofi et al who documented a 20% decrease in STEMI hospitalizations worldwide which also included a decrease >50% in their analysis thus highlighting the possibility of global underestimation of ACS cases during pandemic.…”

Adverse Cardiac Effects of SARS-CoV-2 Infection

“…51 In addition, there may have been a fear component involved in the reduction in cardiac emergencies, whereby people did not seek medical attention for complaints relating to cardiac symptoms. 52 However, patients experiencing ST-elevation MI who were admitted during the first wave of the COVID-19 pandemic experienced longer total ischaemic times, resulting in a more severe disease status upon hospital admission and a higher rate of in-hospital adverse events compared with a comparable pre-COVID-19 period. 40,41,52 These adverse outcomes resulted from multiple confounding factors, including viral infection triggering additional ischaemia, healthcare systems that were overwhelmed by the pandemic and a delay in procedures following admission because of the need for precautionary infection control measures.…”