Impact of COVID-19 Pandemic on STEMI Networks in Central Romania
Roxana Hodas1,2, Imre Benedek1,2, Nora Rat1,2
1Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania.
Insights
The COVID-19 pandemic reduced ST-segment elevation myocardial infarction (STEMI) admissions but strained the regional STEMI network's ability to transfer critical cases. While the interventional center remained functional, the network struggled to timely manage severe STEMI patients during the initial lockdown.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- The COVID-19 pandemic significantly impacted emergency healthcare services.
- Cardiovascular emergencies, particularly ST-segment elevation myocardial infarction (STEMI), require rapid and efficient management.
- Regional STEMI networks are crucial for timely reperfusion therapy.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on a regional STEMI network.
- To assess changes in acute myocardial infarction (AMI) and STEMI patient management during the pandemic lockdown.
- To analyze the functionality of a high-volume STEMI network hub and its capacity to handle critical cases.
Main Methods:
- A single-center study compared patient admissions for acute coronary syndrome (ACS) during the COVID-19 lockdown (Q2 2020) with the same period in 2019.
- Analysis included all consecutive patients referred for AMI and STEMI.
- Door-to-balloon times and the transfer of critical STEMI cases were assessed.
Main Results:
- Hospital admissions for AMI decreased by 22.3%, with a significant increase in the proportion of AMI cases from 38% to 68% of total admissions.
- Late STEMI presentations reduced by 55%.
- While the hub's interventional function was maintained (door-to-balloon time increased from 34 to 41 min), the network transferred fewer critical STEMI cases, with a 56.1% reduction in KILLIP class III and resuscitated out-of-hospital cardiac arrest cases reaching the unit.
Conclusions:
- The COVID-19 outbreak did not critically impair the interventional center's direct functionality.
- The regional STEMI network's capacity to transfer critical STEMI patients to the cathlab was limited during the early lockdown period.
- Even well-established STEMI networks faced challenges in managing the most severe STEMI cases during the pandemic's initial phase.
Abstract:
The COVID-19 pandemic has had a major impact on cardiovascular emergencies. The aim of this study was to investigate the impact of the COVID-19 pandemic on a regional network for management of ST-segment elevation acute myocardial infarction (STEMI).
Methods:
We report a single center's experience of patients hospitalized for ACS in a high-volume hub of a STEMI network during the lockdown (in the first pandemic trimester), compared with the same time interval of the previous year and including all consecutive patients referred for an AMI during the second trimester of 2020 (from April to June) or during the same time interval of the previous year, 2019.
Results:
The absolute number of hospital admissions for AMI decreased by 22.3%, while the non-AMI hospitalizations decreased by 77.14% in Q2-2020 compared to Q2-2019 (210 vs. 48, p < 0.0001). As a consequence, the percentage of AMI cases from the total number of hospital admission increased from 38% to 68% (p < 0.0001), AMI becoming the dominant pathology. In the STEMI group there was a significant reduction of 55% in the absolute number of late STEMI presentations. Functionality of the STEMI network at the hub level did not present a significant alteration with only a minor increase in the door-to-balloon time, from 34 min to 41 min. However, at the level of the network we recorded a lower number of critical cases transferred to the interventional center, with a dramatic reduction of 56.1% in the number of critical STEMI cases arriving in the acute cardiac care unit (17.0% vs. 7.3%, p-0.04 for KILLIP class III, and 21.17% vs. 11.11%, p = 0.08 for resuscitated out of hospital cardiac arrest).
Conclusions:
The COVID-19 outbreak did not have a major impact on the interventional center's functionality, but it limited the capacity of the regional STEMI network to bring the critical patient with complicated STEMI to the cathlab in time during the first months of the lockdown. Even a very well-functioning STEMI network like the one in Central Romania had difficulties bringing the most critical STEMI cases to the cathlab in time.
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