Abstract:The current study aimed to examine the impact of COVID-19 pandemic on patient-related delay with ST-segment elevation myocardial infarction (STEMI) at a tertiary center in the United Kingdom. The study demonstrated a significant delay in symptom-to-first medical contact and a higher cardiac troponin-I level on admission in patients with STEMI during the COVID-19 pandemic versus the pre-COVID era.
“…(b) Older patients with an ACS (mainly UA) presented less frequently to the hospitals during the COVID‐19 period; older patients were considered from the start of the outbreak as one of the population groups at highest risk from COVID‐19 and were urged early by mass media and government authorities to avoid social contact and be self‐confined. (c) During the COVID‐19 outbreak, ACS patients presented more frequently with LV systolic impairment, which may serve as a surrogate marker for delayed MI presentation, and is supported by longer times from symptom onset to first medical contact observed for MI patients in other countries 9‐11 …”
Background: Reports from countries severely hit by the COVID-19 pandemic suggest a decline in acute coronary syndrome (ACS)-related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID-19 incidence are not known.
“…(b) Older patients with an ACS (mainly UA) presented less frequently to the hospitals during the COVID‐19 period; older patients were considered from the start of the outbreak as one of the population groups at highest risk from COVID‐19 and were urged early by mass media and government authorities to avoid social contact and be self‐confined. (c) During the COVID‐19 outbreak, ACS patients presented more frequently with LV systolic impairment, which may serve as a surrogate marker for delayed MI presentation, and is supported by longer times from symptom onset to first medical contact observed for MI patients in other countries 9‐11 …”
Background: Reports from countries severely hit by the COVID-19 pandemic suggest a decline in acute coronary syndrome (ACS)-related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID-19 incidence are not known.
“…3 ). Several studies have evaluated the delay in first medical contact or door-to-balloon time; (6, 10, 16-18, 21) however, only 1 study, which included 9 patients during the pandemic, assessed all of the stages from symptom-onset to balloon dilatation ( 17 ). Our study provides detailed information about delays at each step in a large nationwide population.…”
Objective:
Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1).
Methods:
The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period.
Results:
A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20–3.22) for NSTEMI, p=0.007; and 2.08 (1.38–3.13) for STEMI, p<0.001].
Conclusion:
The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients’ fear of using healthcare services and mitigate the potential complications of AMI during the pandemic.
“… Figure 4 Summary of reports in literature demonstrating the drop in STEMI volume and relative prevalence of COVID-19. 1 , 2 , 6 , 7 , 11 , 13 , 14 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 . For each country, the total number of COVID-19 cases, the cases per million, the drop in STEMI volume by percentages and the size of the study are shown.…”
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,
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