The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

Abstract

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

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

“…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.…”

Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic

“…Most previous studies have suggested longer total ischemia time and time from first medical contact do angiography in patients admitted during COVID-19 pandemic [1,25,29]. Furthermore, some investigators have also demonstrated an escalated risk of death and adverse events [8,25,29]. However, retrospective nature without balanced rate of risk factors and low sample size might limit the generalizability of these studies.…”

“…Pandemicspecific protocols for preparing personal protective equipment and obligatory COVID-19 testing consume additional time and extend the time for reperfusion [1][2][3][4]10,12]. Most previous studies have suggested longer total ischemia time and time from first medical contact do angiography in patients admitted during COVID-19 pandemic [1,25,29]. Furthermore, some investigators have also demonstrated an escalated risk of death and adverse events [8,25,29].…”

COVID-19 Severity and Cardiovascular Disease: An Inseparable Link

“…Our hospital admission analysis showed a trend toward a reduction in acute coronary syndromes incidence, with a substantial increase in STEMI fatality rate and complications during the pandemic, compared with 2019 [8]. This was explained by the decrease in percutaneous coronary intervention (PCI) procedures [9], with an annual 634 PCI patients falling by 25.7% during the COVID-19 period (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and prolongation of the time from first medical contact to needle (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Such significant change in practice was interpreted on the basis of patients' fear of visiting the hospital, lack of organized emergency pathways for acute coronary syndromes during the COVID-19 period, and occasional misdiagnosis in patients with respiratory symptoms.…”