The STEMI phenomenon during the COVID-19 pandemic: what is beneath the tip of the iceberg?

Cammann, Victoria L.; Templin, Christian

doi:10.1136/heartjnl-2021-320383

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…To the best of our knowledge, this is the first study to evaluate clinical outcomes in STEMI complicated by OHCA during the COVID-19 pandemic as compared to pre-pandemic era. A decrease in the number of STEMI patients and a higher rate of OHCA counts were widely reported despite geographical location since the pandemic began [1][2][3][4]7,[21][22][23][24][25][26]. Several factors might partially explain these findings.…”

Section: Discussionmentioning

confidence: 99%

“…The COVID-19 pandemic engenders profound changes in the functioning and effectiveness of the healthcare system [1][2][3][4]. A sudden surge of infected patients and mandatory swab tests with pandemic-specific protocols forced fragmentation of attention and resources of medical staff.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, patients with ST-segment-elevation myocardial infarction (STEMI) might experience delays in treatment and prolonged time to achieve reperfusion. More importantly, delayed reperfusion may aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients [2][3][4][5][6]. Furthermore, fear of contamination of SARS-CoV-2 might result in more reserved attitudes toward resuscitation practice and a lower rate of successful cardiopulmonary resuscitation (CPR) [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest

Tokarek

Dziewierz

Zeliaś³

et al. 2022

IJERPH

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Patients with ST-segment-elevation myocardial infarction (STEMI) treated during the COVID-19 pandemic might experience prolonged time to reperfusion. The delayed reperfusion may potentially aggravate the risk of out-of-hospital cardiac arrest (OHCA) in those patients. Limited access to healthcare, more reluctant health-seeking behaviors, and bystander readiness to render life-saving interventions might additionally contribute to the suggested change in the risk of OHCA in STEMI. Thus, we sought to explore the effects of the COVID-19 outbreak on treatment delay and clinical outcomes of patients with STEMI with OHCA. Overall, 5,501 consecutive patients with STEMI complicated by OHCA and treated with primary percutaneous coronary intervention with stent implantation were enrolled. A propensity score matching was used to obviate the possible impact of non-randomized design. A total of 740 matched pairs of patients with STEMI and OHCA treated before and during the COVID-19 pandemic were compared. A similar mortality and prevalence of periprocedural complications were observed in both groups. However, patients treated during the COVID-19 outbreak experienced longer delays from first medical contact to angiography (88.8 (±61.5) vs. 101.4 (±109.8) [minutes]; p = 0.006). There was also a trend toward prolonged time from pain onset to angiography in patients admitted to the hospital in the pandemic era (207.3 (±192.8) vs. 227.9 (±231.4) [minutes]; p = 0.06). In conclusion, the periprocedural outcomes in STEMI complicated by OHCA were comparable before and during the COVID-19 era. However, treatment in the COVID-19 outbreak was associated with a longer time from first medical contact to reperfusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest

Tokarek

Dziewierz

Zeliaś³

et al. 2022

IJERPH

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“… 1 , 2 The outbreak of this pandemic has resulted in a mass reorganization of healthcare facilities, with a reluctance of admissions and postponement of elective procedures. 3 Patients admitted with SARS-CoV-2 infection may have concurrent cardiovascular risk factors such as hypertension and diabetes, which predispose them to coronary artery disease. 4 At the same time, it has also been shown that SARS-CoV-2 infection and the resulting hypercoagulable state can hasten thrombus formation and can cause myocardial ischemia and infarction.…”

Section: Introductionmentioning

confidence: 99%

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

Wasef¹,

Thomas²,

Haq³

et al. 2023

Journal of Community Hospital Internal Medicine Perspectives

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As the novel COVID-19 pandemic was on the rise, its impact on the healthcare system was devastating. Patients became more reluctant to present to the hospital and elective procedures were being postponed for patient safety. We wanted to assess the effects of the COVID-19 pandemic on the door-to-device time in our small community hospital in the heart of Trenton, New Jersey. We created a retrospective study that evaluated all STEMI cases that presented to our institute from January 2018 until the end of May, 2021. Our primary outcome was the door-to-device time. Secondary outcomes were the length of hospital stay, ICU admission, length of ICU stay, cardiac arrest, and death during the hospitalization. We studied 114 patients that presented with STEMI to our emergency department, 77 of these patients presented pre-COVID-19, and 37 presented during the pandemic. Our median door-to-device for STEMI cases pre-COVID-19, and during the pandemic were 70 min (IQR 84–57) and 70 min (IQR 88–59) respectively with no significant difference found (P-value 0.55, Mann Whitney Test). It is, however, interesting to note that the number of STEMI admissions significantly decreased during the pandemic era. There are limitations to our study, most noticeably the number of STEMI cases at our small community hospital which limits its generalizability. Moreover, we did not assess other comorbidities which might have confounded our outcomes and we were also unable to follow patients post-discharge to assess the long-term sequela of their STEMI admission. Therefore, more dedicated studies of this clinical conundrum are required to further assess and implement guidelines for the future.

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“…In the accompanying editorial, Cammann and Templin2 discuss the potential reasons for fewer patients presenting with an acute coronary syndrome during the pandemic, pointing out that this represents a failure to diagnosis and treat patients appropriately, not a reduction in disease prevalence. Delayed treatment or suboptimal intervention for acute coronary syndromes is likely to result in long-term detrimental consequences (figure 2).…”

mentioning

confidence: 99%

Heartbeat: delayed and inadequate treatment of acute coronary syndromes during the COVID-19 pandemic

Otto

2022

Heart

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The STEMI phenomenon during the COVID-19 pandemic: what is beneath the tip of the iceberg?

Cited by 5 publications

References 7 publications

Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest

Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest

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

Heartbeat: delayed and inadequate treatment of acute coronary syndromes during the COVID-19 pandemic

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