[Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience]
Oriol Rodríguez-Leor1,2,3, Belén Cid-Álvarez4, Armando Pérez de Prado5
1Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
Insights
The COVID-19 pandemic led to fewer ST-segment elevation myocardial infarction (STEMI) patients receiving treatment, with longer reperfusion times and a doubled in-hospital mortality rate. Primary percutaneous coronary intervention remained the standard reperfusion strategy.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Context:
- The COVID-19 pandemic significantly disrupted healthcare systems globally.
- Impact on acute cardiovascular events, such as ST-segment elevation myocardial infarction (STEMI), remains incompletely understood.
- STEMI management relies on timely reperfusion therapy, making it vulnerable to pandemic-related disruptions.
Purpose:
- To evaluate the impact of the COVID-19 outbreak on the management and outcomes of patients with STEMI.
- To compare STEMI patient characteristics, treatment strategies, and in-hospital mortality before and during the COVID-19 pandemic.
- To assess changes in reperfusion times and the incidence of SARS-CoV-2 infection in STEMI patients.
Summary:
- A nationwide Spanish registry study compared STEMI patients treated before and during the COVID-19 outbreak.
- Fewer STEMI patients were treated during the pandemic, with a significant increase in ischemic time.
- In-hospital mortality rose by approximately two-fold during the COVID-19 outbreak, even after adjusting for confounders.
- Primary percutaneous coronary intervention remained the predominant reperfusion strategy (>94%) in both periods.
- The incidence of concurrent STEMI and SARS-CoV-2 infection was relatively low (6.3% in the 2020 cohort).
Impact:
- The COVID-19 pandemic adversely affected STEMI care, leading to delayed treatment and increased mortality.
- Despite challenges, established reperfusion strategies like primary percutaneous coronary intervention were maintained.
- Findings highlight the need for robust strategies to ensure timely STEMI care during public health emergencies.
- Understanding these impacts is crucial for optimizing cardiovascular care during future pandemics.
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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