ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in
Guillaume Bonnet1, Vassili Panagides2, Mathieu Becker3
1Université de Paris, Paris Cardiovascular Research Center (PARCC), INSERM, UMR-S970, 75015 Paris, France.
Insights
During the COVID-19 pandemic, ST-segment elevation myocardial infarction (STEMI) admissions decreased, leading to longer treatment delays and increased mechanical complications in France. Patients should seek immediate medical help for heart attack symptoms.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Healthcare systems faced challenges during the COVID-19 pandemic.
- The impact of the pandemic on ST-segment elevation myocardial infarction (STEMI) care in France was unclear.
Purpose of the Study:
- To compare STEMI admissions, treatment delays, and outcomes in France during the first COVID-19 peak versus 2019.
- To assess the effect of the pandemic on reperfusion times and patient outcomes for STEMI.
Main Methods:
- A nationwide French survey analyzed data from 65 centers for STEMI patients undergoing revascularization.
- Data from March 1 to May 31, 2020 (pandemic peak), were compared to the same period in 2019.
- The primary outcome was a composite of in-hospital death or mechanical complications.
Main Results:
- STEMI admissions decreased by 13.9% per week during the pandemic peak.
- Treatment delays increased, primarily due to longer times from symptom onset to first medical contact.
- Mechanical complications rose from 0.9% in 2019 to 1.7% in 2020, impacting the primary outcome.
Conclusions:
- The COVID-19 pandemic's first peak in France saw reduced STEMI admissions linked to longer ischemic times and more mechanical complications.
- Patient-related delays significantly contributed to increased treatment times.
- Public health messaging should encourage prompt medical attention for potential heart attack symptoms.
Background:
Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.
Aim:
To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.
Methods:
In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.
Results:
A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.
Conclusions:
During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.
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