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

Abstract

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.

Comparison of the Characteristics, Management, and Outcomes of STEMI Patients Presenting With vs. Those of Patients Presenting Without COVID-19 Infection: A Systematic Review and Meta-Analysis

“…Nevertheless, using this method to calculate SDs may entail inaccuracy and make the SDs greater than the mean in some cases, which is an inherent feature of the method ( 17 ). Second, the disparity in study size may affect the weighting of the studies and the pooled effect size, which is innate to meta-analyses ( 53 , 54 ). Third, a high degree of heterogeneity was observed in some outcomes.…”

Impacto da pandemia de COVID-19 na assistência aos pacientes com infarto agudo do miocárdio

“…Os principais resultados encontrados estão sintetizados nos Quadros 01, 02 e 03 referentes às variáveis analisadas, respectivamente, a diminuição do número de admissões, ao aumento do tempo porta-balão e ao prognóstico, que foi medido pela mortalidade. Quando analisados dados das pesquisas sobre o atraso na assistência do paciente com IAM, os estudos, de forma unânime, relataram uma redução do número de admissões de pacientes com IAM tendo sido relatado uma redução de quase 80% dessa admissão (Kamarullah et al, 2021).…”

Comparison of STEMI Door-to-Device Time during the COVID-19 crisis in a New Jersey Inner City Community Hospital

“…One meta-analysis by Kamarullah used studies from around the world (including Saudi Arabia, Turkey, and Japan) to show a significant reduction in STEMI admissions and prolonged door-to-device time during the pandemic (SMD = 1.02, p < 0.001) 8 . Some of the reasons the author mentioned for this discrepancy were the stay-at-home regulations that were implemented earlier on in the pandemic and the screening tests all patients were required to undergo to diminish the rate of transmission 8 .…”