COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction
Satoshi Kitahara1,2, Masashi Fujino3, Satoshi Honda1
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Insights
The COVID-19 pandemic led to more mechanical complications in ST-elevation myocardial infarction (STEMI) patients. Public health messaging to stay home may have worsened outcomes by delaying critical care for heart attack symptoms.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Regional reports indicated reduced acute myocardial infarction (AMI) presentations during the COVID-19 pandemic.
- Little is known about the pandemic's impact on mechanical complications and mortality in ST-elevation myocardial infarction (STEMI) patients.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on STEMI mechanical complications and mortality.
- To analyze STEMI patient presentations, mechanical complication incidence, and mortality before and after the pandemic-related state of emergency declaration in Japan.
Main Methods:
- A single-center retrospective cohort study analyzed STEMI patients.
- Data included patient presentations, mechanical complications, and mortality.
- Comparisons were made between the periods before and after the COVID-19 state of emergency declaration (April 7, 2020).
Main Results:
- Late STEMI presentation increased significantly post-declaration (25.4% vs 14.2%, p=0.03).
- Mechanical complications rose from 3.6% to 14.3% (p<0.001).
- In-hospital mortality remained comparable (6.2% vs 6.4%, p=0.95).
Conclusions:
- The COVID-19 pandemic was associated with an increased incidence of mechanical complications in STEMI patients.
- Public health guidance to stay home without emphasizing immediate medical attention for heart attack symptoms may have contributed to worse outcomes.
Objective:
Although there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.
Methods:
This single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.
Results:
We analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.
Conclusions:
Following the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.
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