[COVID-19 and STEMI]

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The COVID-19 pandemic significantly impacted emergency medical services, particularly for ST-elevation myocardial infarction (STEMI).
• Studies globally observed a decrease in STEMI hospital admissions, attributed to patient apprehension about hospital-acquired infections.
• Treatment delays during lockdowns exacerbated ischemic times and increased mortality rates.

Purpose of the Study:

• To analyze the effects of the COVID-19 pandemic on STEMI management and outcomes.
• To review the challenges in achieving timely revascularization during pandemic-related restrictions.
• To highlight the unique presentation and poor prognosis of STEMI in COVID-19 patients.

Main Methods:

• Analysis of data from the France PCI registry and other international studies.
• Review of scientific society recommendations for STEMI management during the COVID-19 pandemic.
• Examination of clinical presentations and angiographic findings in STEMI patients with COVID-19.

Main Results:

• A significant reduction in STEMI hospitalizations was observed worldwide.
• Achieving time targets for STEMI revascularization (<120 minutes) became exceedingly difficult during lockdowns.
• STEMI patients with COVID-19 frequently presented atypically, often without coronary obstruction on angiography, and had a worse prognosis.
• Excess mortality was linked to longer delays and increased ischemic times, particularly in epidemic hotspots.

Conclusions:

• The pandemic necessitated revised strategies for managing STEMI, including specific guidelines from scientific societies.
• Public information campaigns and adapted organizational structures are crucial for mitigating the impact of coronary emergencies during epidemics.
• Addressing patient fears and overcoming logistical hurdles are vital to improve outcomes for STEMI during future health crises.