Acute ST-Elevation Myocardial Infarction Before and During the COVID-19 Pandemic: What is the Clinically Significant
Naeem Mengal1, Tahir Saghir1, Syed N Hassan Rizvi1
1Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
Insights
During the COVID-19 pandemic, ST-elevation myocardial infarction (STEMI) patients experienced lower admission rates but longer total ischemic times and increased mortality compared to pre-pandemic eras.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has altered hospital admissions for acute ST-elevation myocardial infarction (STEMI).
- Cardiac manifestations of COVID-19 are complex, including STEMI, myocarditis, and cardiomyopathy.
- Increased mortality and morbidity are observed in STEMI patients during the pandemic.
Purpose of the Study:
- To compare clinical and angiographic data of STEMI patients during the COVID-19 era versus the pre-COVID era.
- To evaluate changes in STEMI admission rates, ischemic times, and mortality.
- To assess the impact of the pandemic on STEMI management and outcomes.
Main Methods:
- Analysis of clinical and angiographic characteristics of STEMI patients undergoing primary percutaneous coronary intervention (PCI).
- Comparison of three groups: March-April 2020 (COVID-19 era), January-February 2020 (pre-COVID), and March-April 2019 (pre-COVID).
- Primary outcome variables included admission rate, mean total ischemic time (TIT), coronary artery disease burden, ejection fraction, and in-hospital mortality.
Main Results:
- Group A (COVID-19 era) had a lower STEMI admission rate (18.6 admissions/day) compared to Group B (26.01/day) and Group C (24.8/day) (p<.001).
- Mean total ischemic time (TIT) was significantly higher in Group A (429.25 minutes) versus Group B (359.78 minutes) and Group C (346.75 minutes) (p<.001).
- Higher in-hospital mortality was observed in Group A compared to Group C (p<.001).
Conclusions:
- STEMI patients during the COVID-19 pandemic exhibited lower admission rates, longer total ischemic times, and higher mortality.
- Physicians must remain vigilant for increased STEMI morbidity and mortality during the pandemic.
- Timely management of STEMI patients is crucial to mitigate adverse outcomes during public health crises.
Abstract:
Background In the current coronavirus disease-2019 (COVID-19) pandemic, the pattern of hospital admissions for acute ST-elevation myocardial infarction (STEMI) is changing, and increased mortality and morbidity is being noted in these patients. Cardiac manifestations of COVID-19 are complex and include STEMI, myocarditis, myocardial injury, and cardiomyopathy. The objective of our study was to compare the data of patients with STEMI presenting in COVID-19 versus the non-COVID-19 era. Methods We analyzed the clinical and angiographic characteristics of STEMI patients undergoing primary percutaneous coronary intervention (PCI) at our center. The primary outcome variables were admission rate for STEMI, mean total ischemic time (TIT), coronary artery disease burden, mean ejection fraction, and in-hospital mortality for three defined groups. Group A consisted of patients who underwent primary PCI from March through April 2020. Group B included patients who underwent primary PCI from January to February 2020. Group C consisted of patients who underwent primary PCI from March to April 2019. We then compared the data among the three groups and calculated any significant p-value (p<.001). Results In Group A, 1139 patients were admitted for primary PCI. The mean admission rate was 18.6 ± 4.36 admissions per day. There were 1535 patients in Group B and an admission rate of 26.01 ± 4.90 (p<.001 compared to Group A). In Group C, there were 1537 patients and an admission rate of 24.8 ± 4.55 (p<.001, compared to Group A). The mean TIT was 429.25±272.16 minutes for Group A, 359.78±148.04 minutes for Group B, and 346.75±207.31 minutes for Group C (p<.001). A higher mortality rate was noted in Group A (COVID-19 era) versus Group C (non-COVID-19 era; p<.001). Conclusions A lower admission rate, higher TIT, and higher mortality rates were noted in patients with acute STEMI during the COVID-19 pandemic compared to the pre-COVID era. During the COVID-19 pandemic, physicians should bear in mind that patients with STEMI have increased mortality and morbidity. Where possible, efforts should be made for timely management of these critical patients to decrease mortality.
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