Effect of the COVID-19 Pandemic on Treatment Delays in Patients with ST-Segment Elevation Myocardial Infarction
Sebastian J Reinstadler1, Martin Reindl1, Ivan Lechner1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Insights
The COVID-19 pandemic in Austria led to a 1.7-fold increase in ischemic times for ST-elevation myocardial infarction (STEMI) patients. Patient-related factors are the likely cause, necessitating interventions to prevent cardiac damage.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic and associated restrictions may impact treatment times for acute myocardial infarction.
- Understanding these effects is crucial for patient outcomes during public health crises.
Purpose of the Study:
- To investigate the influence of the COVID-19 outbreak on ischemic times in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- A cohort of 163 STEMI patients treated with primary PCI across seven Austrian hospitals between February and April 2020 was analyzed.
- Ischemic times, door-to-balloon times, and post-interventional outcomes were assessed in relation to COVID-19 restrictions and infection rates.
Main Results:
- STEMI admissions decreased during the study period, while total ischemic times significantly increased (p=0.006), rising from 164 min to 275 min.
- Door-to-balloon times remained constant, but rates of Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 decreased significantly (p=0.02).
- In-hospital death and re-infarction rates were comparable across different time periods.
Conclusions:
- The COVID-19 outbreak in Austria was associated with a substantial increase in ischemic times for STEMI patients, likely driven by patient-related factors.
- Proactive measures are required to mitigate delays and prevent further myocardial damage during the ongoing pandemic.
Abstract:
Coronavirus disease 19 (COVID-19) and its associated restrictions could affect ischemic times in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to investigate the influence of the COVID-19 outbreak on ischemic times in consecutive all-comer STEMI patients. We included consecutive STEMI patients (n = 163, median age: 61 years, 27% women) who were referred to seven tertiary care hospitals across Austria for primary percutaneous coronary intervention between 24 February 2020 (calendar week 9) and 5 April 2020 (calendar week 14). The number of patients, total ischemic times and door-to-balloon times in temporal relation to COVID-19-related restrictions and infection rates were analyzed. While rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%)), total ischemic times increased from 164 (interquartile range (IQR): 107-281) min (calendar week 9/10) to 237 (IQR: 141-560) min (calendar week 11/12) and to 275 (IQR: 170-590) min (calendar week 13/14) (p = 0.006). Door-to-balloon times were constant (p = 0.60). There was a significant difference in post-interventional Thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients treated during calendar week 9/10 (97%), 11/12 (84%) and 13/14 (81%; p = 0.02). Rates of in-hospital death and re-infarction were similar between groups (p = 0.48). Results were comparable when dichotomizing data on 10 March and 16 March 2020, when official restrictions were executed. In this cohort of all-comer STEMI patients, we observed a 1.7-fold increase in ischemic time during the outbreak of COVID-19 in Austria. Patient-related factors likely explain most of this increase. Counteractive steps are needed to prevent further cardiac collateral damage during the ongoing COVID-19 pandemic.
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