One-year outcomes of patients with ST-segment elevation myocardial infarction during the COVID-19 pandemic
Kailun Phua1, Nicholas W S Chew2, Vincent Sim3
1Department of Medicine, National University Health System, Singapore, Singapore.
Insights
The COVID-19 pandemic did not worsen long-term outcomes for ST-segment elevation myocardial infarction (STEMI) patients despite initial adverse in-hospital events. One-year mortality, readmissions, and recurrent events remained comparable to pre-pandemic levels.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic necessitated stringent infection control measures, impacting healthcare delivery for acute conditions like ST-segment elevation myocardial infarction (STEMI).
- Previous studies indicated adverse short-term outcomes for STEMI patients during the pandemic, but long-term effects remained unclear.
Purpose of the Study:
- To evaluate the 1-year clinical outcomes of STEMI patients treated during the COVID-19 pandemic in Singapore.
- To compare cardiac-related mortality, readmissions, and recurrent coronary events between patients treated before, during, and before the pandemic.
Main Methods:
- A retrospective study of 321 STEMI patients undergoing primary percutaneous coronary intervention (PCI) at a tertiary hospital.
- Patients were categorized into three groups: Before Outbreak Response (BOR), During Outbreak Response (DOR), and a control group from a prior year.
- One-year follow-up assessed cardiac-related mortality, readmissions, and recurrent coronary events.
Main Results:
- While in-hospital outcomes were worse in the BOR and DOR groups compared to the control, no significant differences were observed in 1-year cardiac-related mortality (8.7% BOR, 7.1% DOR, 4.8% control).
- One-year cardiac-related readmissions (15.1% BOR, 11.6% DOR, 12.0% control) and recurrent coronary events (3.2% BOR, 1.8% DOR, 1.2% control) were also comparable across the groups.
- Higher rates of additional PCI during the index admission were noted in the DOR group compared to BOR and control (p=0.027).
Conclusions:
- STEMI patients treated during the COVID-19 pandemic in Singapore experienced comparable 1-year long-term outcomes to those treated in the pre-pandemic era.
- Despite potential challenges and initial adverse events during the pandemic, established STEMI treatment protocols ensured sustained patient recovery.
- The findings suggest that stringent infection control measures did not negatively impact the long-term prognosis for STEMI patients.
Abstract:
The pandemic has led to adverse short-term outcomes for patients with ST-segment elevation myocardial infarction (STEMI). It is unknown if this translates to poorer long-term outcomes. In Singapore, the escalation of the outbreak response on February 7, 2020 demanded adaptation of STEMI care to stringent infection control measures. A total of 321 patients presenting with STEMI and undergoing primary percutaneous coronary intervention at a tertiary hospital were enrolled and followed up over 1-year. They were allocated into three groups based on admission date-(1) Before outbreak response (BOR): December 1, 2019-February 6, 2020, (2) During outbreak response (DOR): February 7-March 31, 2020, and (3) control group: November 1-December 31, 2018. The incidence of cardiac-related mortality, cardiac-related readmissions, and recurrent coronary events were examined. Although in-hospital outcomes were worse in BOR and DOR groups compared to the control group, there were no differences in the 1-year cardiac-related mortality (BOR 8.7%, DOR 7.1%, control 4.8%, p = 0.563), cardiac-related readmissions (BOR 15.1%, DOR 11.6%, control 12.0%, p = 0.693), and recurrent coronary events (BOR 3.2%, DOR 1.8%, control 1.2%, p = 0.596). There were higher rates of additional PCI during the index admission in DOR, compared to BOR and control groups (p = 0.027). While patients admitted for STEMI during the pandemic may have poorer in-hospital outcomes, their long-term outcomes remain comparable to the pre-pandemic era.
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