Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience
Oriol Rodríguez-Leor1, Belén Cid-Álvarez2, Armando Pérez de Prado3
1Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
Insights
The COVID-19 outbreak led to fewer ST-segment elevation myocardial infarction (STEMI) patients and longer ischemic times. In-hospital mortality significantly increased during the pandemic, despite consistent reperfusion strategies.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic has significantly impacted healthcare systems globally.
- The effect on acute cardiovascular events, specifically ST-segment elevation myocardial infarction (STEMI), remains under investigation.
- Understanding changes in STEMI management during the pandemic is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the impact of the COVID-19 outbreak on STEMI patient numbers and management strategies.
- To compare in-hospital outcomes for STEMI patients treated before and during the COVID-19 pandemic.
- To identify changes in reperfusion times and mortality rates associated with the pandemic.
Main Methods:
- A retrospective, observational study was conducted using a nationwide registry from 75 STEMI centers in Spain.
- Patients were divided into two cohorts: pre-COVID-19 and during COVID-19.
- Demographic data, procedural characteristics, and 30-day in-hospital outcomes were compared between cohorts.
Main Results:
- A 27.6% decrease in suspected STEMI patients and a 22.7% decrease in confirmed STEMI cases were observed during the COVID-19 outbreak.
- Primary percutaneous coronary intervention (PCI) remained the dominant reperfusion strategy (>94%) in both cohorts.
- Patients treated during the pandemic experienced longer ischemic times (233 vs. 200 minutes) and a significant increase in in-hospital mortality (7.5% vs. 5.1%).
- The adjusted odds ratio for in-hospital mortality during COVID-19 was 1.88.
- SARS-CoV-2 infection occurred in 6.3% of hospitalized patients in the 2020 cohort.
Conclusions:
- The COVID-19 pandemic was associated with a reduced number of STEMI patients treated and increased in-hospital mortality.
- Despite unchanged reperfusion strategies, median symptom onset to reperfusion times increased.
- The study highlights the adverse effects of the pandemic on STEMI care and outcomes.
Introduction And Objectives:
The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.
Methods:
Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.
Results:
Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.
Conclusions:
The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.
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