Impact in total ischemic time and ST-segment elevation myocardial infarction admissions during COVID-19
Sharon Bruoha1, Chaim Yosefy2, Enrique Gallego-Colon2
1Interventional Cardiology Unit, Barzilai Medical Center, The Ben-Gurion University of the Negev, Israel.
Insights
The COVID-19 pandemic saw a 34.54% reduction in acute coronary syndrome (ACS) admissions, with longer in-hospital delays for ST-elevation myocardial infarction (STEMI) care. However, door-to-balloon times remained under 90 minutes, maintaining critical treatment standards.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Cardiovascular disease remains a leading cause of death, with acute coronary syndromes (ACS) contributing significantly.
- The COVID-19 pandemic may have compromised the timely management of ACS due to overwhelming healthcare demands.
- Reducing total ischemic time (TIT) is crucial for improving outcomes in ACS patients.
Purpose of the Study:
- To evaluate delays in total ischemic time (TIT) for ST-segment elevation myocardial infarction (STEMI) patients before and during the COVID-19 pandemic.
- To assess the impact of the pandemic on the timeliness of ACS care and in-hospital management.
- To identify specific time intervals affected by pandemic-related healthcare changes.
Main Methods:
- A retrospective analysis of 212 ST-segment elevation myocardial infarction (STEMI) patients admitted between July 2018 and June 2020.
- Utilized timeline follow-up forms to document time intervals from symptom onset to reperfusion.
- Compared ACS management metrics, including door-to-ECG, ECG-to-balloon, and door-to-balloon times, between pre-pandemic and pandemic periods.
Main Results:
- ACS admissions decreased by 34.54% during the COVID-19 pandemic.
- Significant in-hospital delays were observed during the pandemic, including increased door-to-ECG (18.41 ± 28.34 vs. 9.43 ± 18.21 seconds, p=0.029) and ECG-to-balloon times (74.39 ± 50.30 vs. 58.25 ± 22.59 seconds, p=0.004).
- Door-to-balloon time also increased during the pandemic (69.31 ± 54.14 vs. 57.41 ± 27.52 seconds, p=0.04).
Conclusions:
- The COVID-19 pandemic led to reduced ACS admissions and prolonged in-hospital delays for STEMI patients.
- Increased delays were attributed to additional testing, triage, infection control protocols, and maintaining care standards.
- Despite delays, door-to-balloon times were successfully maintained under the critical 90-minute threshold.
Background:
Despite the COVID-19 pandemic, cardiovascular disease is still the main cause of death in developed countries. Of these deaths, acute coronary syndromes (ACS) account for a substantial percentage of deaths. Improvement in ACS outcomes, are achieved by reducing the time from symptom onset until reperfusion or total ischemic time (TIT). Nevertheless, due to the overwhelming reality at the beginning of the pandemic, acute coronary syndrome (ACS) care may have been compromised.
Objectives:
We evaluated delays in TIT based on the date and timing of admissions in patients with STEMI, by a timeline follow-up form, before and during the current COVID-19 pandemic.
Methods:
Between July 2018 and June 2020, two hundred and twelve patients diagnosed with ST-segment elevation myocardial infarction (STEMI) were admitted to our medical center. Upon presentation, cases were assigned a timeline report sheet and each time interval, from onset of symptoms to the catheterization lab, was documented. The information was later evaluated to study potential excessive delays throughout ACS management.
Results:
Our data evidenced that during the COVID-19 pandemic ACS admissions were reduced by 34.54%, in addition to several in-hospital delays in patient's ACS management including delays in door-to-ECG time (9.43 ± 18.21 vs. 18.41 ± 28.34, p = 0.029), ECG-to-balloon (58.25 ± 22.59 vs. 74.39 ± 50.30, p = 0.004) and door-to-balloon time (57.41 ± 27.52 vs. 69.31 ± 54.14, p = 0.04).
Conclusions:
During the pandemic a reduction in ACS admissions occurred in our hospital that accompanied with longer in-hospital TIT due to additional tests, triage, protocols to protect and prevent infection within hospital staff, and maintenance of adequate standards of care. However, door-to-balloon time was maintained under 90 min.
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