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Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI
Giuseppe De Luca1, Monica Verdoia2, Miha Cercek3
1Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.
Insights
The COVID-19 pandemic reduced ST-segment elevation myocardial infarction (STEMI) treatments by 19%, particularly for hypertensive patients. Delays in treatment and increased ischemia times contributed to higher mortality during the pandemic.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic may have deterred patients with ST-segment elevation myocardial infarction (STEMI) from seeking emergency care due to contagion fears, potentially increasing mortality.
- Understanding the pandemic's impact on STEMI treatment is crucial for public health strategies.
Purpose of the Study:
- To evaluate the effect of the COVID-19 pandemic on the treatment and outcomes of STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
- To identify patient groups at higher risk of delayed treatment or non-presentation during the pandemic.
Main Methods:
- A retrospective registry analysis of STEMI patients treated with PPCI in European centers during March-April 2019 and 2020.
- Comparison of PPCI incidence, treatment delays (door-to-balloon, total ischemia times), and in-hospital mortality between the two periods.
Main Results:
- A significant 19% reduction in PPCI procedures was observed in 2020 compared to 2019 (Incidence Rate Ratio: 0.811).
- Patients with arterial hypertension showed a notable decrease in admissions during the pandemic.
- Increased door-to-balloon and total ischemia times were associated with the pandemic, potentially contributing to higher mortality.
Conclusions:
- The COVID-19 pandemic significantly impacted STEMI care, leading to reduced PPCI rates and treatment delays, especially in hypertensive patients.
- These delays and reduced interventions likely contributed to increased mortality during the pandemic.
- Findings highlight the need for robust healthcare systems to manage acute cardiovascular events during public health crises.
Background:
The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.
Objectives:
The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment.
Methods:
This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality.
Results:
A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic.
Conclusions:
The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).
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