Care and Outcomes of ST-Segment Elevation Myocardial Infarction Across Multiple COVID-19 Waves
Navraj Malhi1, Nima Moghaddam1, Farshad Hosseini1
1Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
COVID-19 pandemic care for ST-segment elevation myocardial infarction (STEMI) showed significant delays in reperfusion, worsening with each wave. Understanding these gaps is crucial for improving future pandemic cardiac care.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- Concerns exist regarding delays in ST-segment elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.
- It remains unclear if STEMI patient care and outcomes varied across COVID-19 waves and compared to pre-pandemic periods.
Purpose of the Study:
- To compare STEMI incidence, patient characteristics, and treatment outcomes between COVID-19 pandemic waves and a historical non-COVID-19 cohort.
- To examine delays in time from first medical contact (FMC) to reperfusion and diagnosis during the pandemic.
- To identify predictors of delays in STEMI care during the COVID-19 pandemic.
Main Methods:
- A retrospective analysis of consecutive STEMI patients within the Vancouver Coastal Health Authority database.
- Comparison of STEMI incidence, baseline characteristics, and outcomes between three COVID-19 waves and a historical cohort.
- Assessment of time intervals: symptom to FMC, FMC to reperfusion, and FMC to STEMI diagnosis, along with delay predictors.
Main Results:
- STEMI incidence remained consistent (0.93/day during COVID-19 vs. 0.97/day historically).
- Significant delays were observed in FMC-to-reperfusion (116 min vs. 102 min) and FMC-to-STEMI diagnosis (17 min vs. 11 min) during the pandemic.
- FMC-to-device times worsened across pandemic waves (16.3% within 90 min in wave 3 vs. 47.5% historically).
Conclusions:
- The COVID-19 pandemic led to significant delays in STEMI reperfusion care, with increasing delays observed across successive pandemic waves.
- No unique predictors of delay were identified specifically within the COVID-19 cohort.
- Addressing these care gaps is essential for optimizing STEMI management during current and future pandemics.
Background:
There are concerns of delays in ST-segment elevation myocardial infarction (STEMI) care during the COVID-19 pandemic. It is unclear whether the care and outcomes of STEMI patients differ between COVID-19 waves and compared with historical periods.
Methods:
Consecutive patients in the Vancouver Coastal Health Authority STEMI database were included to compare care during 3 distinct waves of the COVID-19 pandemic (9 months; March 2020 to January 2021) with an historical non-COVID-19 cohort. We compared STEMI incidence, baseline characteristics, and outcomes between groups. We also examined time from first medical contact (FMC) to reperfusion, symptom to FMC, and FMC to STEMI diagnosis, as well as predictors of delays.
Results:
The incidence of STEMI was similar during COVID-19 (n = 305; mean 0.93/day) and before COVID-19 (n = 949; 0.97/day; P = 0.80). The COVID-19 cohort showed significant delay in FMC-to-reperfusion (median 116 min vs 102 min; P < 0.001) and FMC-to-STEMI diagnosis (median 17 mins vs 11 min; P < 0.001). Delays in FMC-to-device times worsened across the 3 COVID-19 waves (FMC-to-device time ≤ 90 min in wave 1: 32.9%; in wave 2: 25.6%; in wave 3: 16.3%; P = 0.045 [47.5% before COVID-19; P < 0.001]). There were no significant predictors of delay were unique to the COVID-19 cohort.
Conclusions:
This study demonstrates delays in reperfusion during the COVID-19 pandemic compared with the historical control, with delays increasing during subsequent waves within the pandemic. It is critical to further understand these care gaps to improve STEMI care for future waves of the current and future pandemics.
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