Invasive Management of Acute Myocardial Infarctions During the Initial Wave of the COVID-19 Pandemic
Nina Talmor, Abhinay Ramachandran, Shari B Brosnahan
1The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU School of Medicine, 423 East 23rd Street, Room 12020-W, New York, NY 10010 USA. nathaniel.smilowitz@nyulangone.org.
Insights
The COVID-19 pandemic significantly reduced myocardial infarction (MI) diagnoses and delayed patient care, leading to worse outcomes. Public health emergencies require improved patient education for timely cardiovascular care.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic caused significant healthcare disruptions in New York City.
- The pandemic's impact on acute myocardial infarction (MI) presentation and invasive management is not well understood.
Purpose of the Study:
- To compare MI patient characteristics and invasive management during the COVID-19 pandemic peak versus the prior year.
- To assess changes in MI presentation, treatment, and outcomes during the initial COVID-19 wave.
Main Methods:
- A single-center retrospective study at New York University.
- Compared patients with MI undergoing coronary angiography in March-April 2020 (pandemic) versus March-April 2019.
Main Results:
- Fewer patients (35 vs. 109) underwent angiography in 2020.
- Higher proportion of ST-segment elevation MI (STEMI) in 2020 (48.6% vs. 24.8%).
- Increased peak troponin levels and decreased ejection fraction in 2020.
- Delayed presentation for non-STEMI patients during the pandemic (24 vs. 10 hours).
Conclusions:
- A significant decrease in MI diagnoses managed invasively occurred during the pandemic.
- Patients presenting during the pandemic experienced delayed care and increased myocardial injury.
- Enhanced patient education is crucial for ensuring timely cardiovascular care during public health crises.
Background:
The initial wave of the coronavirus disease 2019 (COVID-19) pandemic resulted in an influx of patients with acute viral illness and profound changes in healthcare delivery in New York City. The impact of this pandemic on the presentation and invasive management of acute myocardial infarction (MI) is not well described.
Methods:
This single-center retrospective study compared patients with MI who underwent invasive coronary angiography at New York University from March-April 2020, during the peak of the first wave of the pandemic, with those presenting in March-April 2019.
Results:
Only 35 patients with MI underwent angiography during the study period in 2020 vs 109 patients in 2019. No differences in comorbidities or baseline medications were identified. The proportion of patients with ST-segment elevation MI (STEMI) was higher in 2020 than in 2019 (48.6% vs 24.8%, respectively; P=.01). Median peak troponin concentration was higher (14.5 ng/mL vs 2.9 ng/mL; P<.01) and left ventricular ejection fraction was lower (43.34% vs 51.1%; P=.02) during the pandemic. Among patients with non-STEMI, time from symptom onset to presentation was delayed in 2020 compared with 2019 (median, 24 hours vs 10 hours; P=.04).
Conclusion:
There was a dramatic decrease in the number of patients with MI undergoing coronary angiography during the first wave of the COVID-19 pandemic. Of those who presented, patients tended to seek care later after symptom onset and had excess myocardial injury. These data indicate a need for improved patient education to ensure timely cardiovascular care during public health emergencies.
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