COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction
Giuseppe De Luca1,2, Magdy Algowhary3, Berat Uguz4
1Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy giuseppe.deluca@med.uniupo.it.
Insights
The COVID-19 pandemic reduced primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) by 16%, particularly in older adults. This led to treatment delays and increased mortality rates.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic initially caused significant disruptions in healthcare delivery globally.
- Studies indicated a reduction in procedures for acute coronary syndromes during the early pandemic phase.
- Data on the impact on ST-elevation myocardial infarction (STEMI) and primary percutaneous coronary intervention (PPCI) required further investigation.
Purpose of the Study:
- To present the final results of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 registry.
- To analyze the impact of the pandemic on PPCI procedures, treatment times, and mortality rates for STEMI patients.
- To extend the initial findings beyond Europe with a larger patient cohort and longer follow-up.
Main Methods:
- A retrospective, multicentre registry study involving 16,674 STEMI patients undergoing PPCI.
- Data collected from 109 high-volume PPCI centers across Europe, Latin America, South-East Asia, and North Africa.
- Comparison of outcomes between March/June 2019 (prepandemic) and March/June 2020 (pandemic), including PPCI incidence, treatment delays (ischaemia and door-to-balloon times), and in-hospital/30-day mortality.
Main Results:
- A significant 16% reduction in PPCI procedures was observed in 2020 compared to 2019 (IRR 0.843, p<0.0001).
- The reduction in PPCI was more pronounced in older adults (>75 years, p=0.015).
- Door-to-balloon time increased (p=0.01) and total ischaemia time increased (p<0.001), correlating with higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day mortality (8% vs 6.5%, p=0.001).
Conclusions:
- The COVID-19 pandemic significantly impacted percutaneous revascularisation for STEMI, leading to a 16% decrease in PPCI procedures.
- Older patients were disproportionately affected, experiencing approximately 20% fewer PPCI procedures.
- Increased treatment delays during the pandemic likely contributed to the observed rise in mortality.
Objective:
The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days).
Methods:
This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality.
Results:
In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic.
Conclusion:
Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic.
Trial Registration Number:
NCT04412655.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:14Myocarditis III: Medical Management