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Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo
Yukihiro Watanabe1,2, Hideki Miyachi1, Kosuke Mozawa1
1Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan.
Insights
The COVID-19 pandemic led to fewer ST-elevation myocardial infarction (STEMI) hospitalizations in Tokyo, with increased delays in treatment and a rise in late presentations. This highlights a need to review STEMI management systems during pandemics.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has strained global healthcare, with unclear impacts on ST-elevation myocardial infarction (STEMI) care in Japan.
- Previous studies suggest negative effects of COVID-19 on STEMI patients, necessitating local investigation.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on STEMI patients in Tokyo.
- To compare hospitalization rates, clinical characteristics, treatment timelines, and outcomes before and during the pandemic.
Main Methods:
- Retrospective, observational cohort study of 398 STEMI patients admitted between January 2018 and March 2021.
- Comparison of data before (pre-March 2020) and after the WHO declared COVID-19 a pandemic.
Main Results:
- A 10.7% reduction in STEMI hospitalizations was observed during the pandemic.
- Late STEMI presentations significantly increased (26.5% vs. 12.1%), with longer onset-to-door and door-to-balloon times.
- In-hospital mortality for STEMI patients was higher during the pandemic, though not statistically significant (9.4% vs. 5.0%).
Conclusions:
- The COVID-19 pandemic negatively impacted STEMI patient care in Tokyo, causing treatment delays and increased late presentations.
- A slight, non-significant increase in mortality was noted, underscoring the need for system review.
- Acute management strategies for STEMI in Japan require re-evaluation in the context of the COVID-19 era.
Abstract:
Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door [241 (IQR: 70-926) vs. 128 (IQR: 66-493) minutes, p=0.028] and door-to-balloon [72 (IQR: 61-128) vs. 60 (IQR: 43-90) min, p<0.001] times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusion The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.