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COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group

Callum D Little1,2, Tushar Kotecha3, Luciano Candilio3

  • 1Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom callumlittle@nhs.net.

Open Heart
|October 27, 2020
PubMed

Insights

Primary percutaneous coronary intervention (PPCI) pathways remained functional during the COVID-19 pandemic, despite reduced ST-segment elevation myocardial infarction (STEMI) admissions. Patients with STEMI and active COVID-19 experienced higher mortality due to increased thrombogenicity.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • The COVID-19 pandemic significantly impacted healthcare systems globally.
  • Understanding its effect on emergency cardiac procedures like primary percutaneous coronary intervention (PPCI) is crucial.
  • ST-segment elevation myocardial infarction (STEMI) requires timely intervention for optimal outcomes.

Purpose of the Study:

  • To assess the impact of COVID-19 on the delivery and outcomes of PPCI.
  • To compare clinical presentation and outcomes of STEMI patients with and without active COVID-19.

Main Methods:

  • A systematic analysis of 348 STEMI cases undergoing PPCI in London during March-April 2020 was conducted.
  • These cases were compared to 440 STEMI cases from the same period in 2019.
  • Key outcomes included ambulance response times, revascularisation timeliness, procedural characteristics, and in-hospital mortality.

Main Results:

  • STEMI admissions decreased by 21% in 2020 compared to 2019, with longer ambulance response times.
  • However, in-hospital revascularisation times and overall mortality were not significantly different between the two periods.
  • STEMI patients with active COVID-19 (46 cases) exhibited increased thrombotic events, higher intensive care unit admissions (32.6% vs 9.3%), longer hospital stays, and significantly higher mortality (21.7% vs 9.3%).

Conclusions:

  • PPCI services can be maintained during major healthcare emergencies.
  • Concomitant COVID-19 infection in STEMI patients is associated with a hyper-thrombotic state and increased mortality.
  • This highlights the critical need for managing thrombogenicity in COVID-19 positive cardiac patients.
Abstract

Keywords:
acute coronary syndromechest painmyocardial infarctionpercutaneous coronary intervention

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