Reconsidering treatment guidelines for acute myocardial infarction during the COVID-19 pandemic
Jing Gao1,2,3, Peng-Ju Lu4, Chang-Ping Li5
1Chest Hospital, Tianjin University, No. 92 Weijin Road Nankai District, Tianjin, 300072, People's Republic of China.
Insights
The COVID-19 pandemic delayed treatment for acute myocardial infarction (AMI) patients. While ST-elevation MI outcomes were similar, non-ST-elevation MI patients faced higher mortality and major adverse cardiac events during the pandemic.
Area of Science:
- Cardiology
- Public Health
- Infectious Diseases
Background:
- The COVID-19 pandemic strained healthcare resources, potentially impacting acute myocardial infarction (AMI) patient care.
- Understanding the pandemic's effect on AMI outcomes is crucial for optimizing patient management.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on outcomes for patients with ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI).
Main Methods:
- Compared outcomes of 254 STEMI/NSTEMI patients from Jan-Feb 2019 (pre-pandemic) with 124 patients from Jan-Feb 2020 (pandemic).
- Analyzed key metrics including time to treatment, reperfusion strategies, and 30-day mortality and major adverse cardiac events (MACE).
Main Results:
- STEMI patients in the pandemic group experienced longer treatment delays but similar mortality and MACE rates.
- NSTEMI patients during the pandemic showed increased conservative therapy, reduced reperfusion, longer delays, and significantly higher 30-day mortality and MACE.
- Thrombolytic therapy increased for STEMI, while primary percutaneous intervention decreased during the pandemic.
Conclusions:
- The COVID-19 pandemic led to treatment delays for AMI patients, particularly impacting NSTEMI outcomes.
- Prompt thrombolytic therapy is vital for STEMI when intervention is unavailable; invasive reperfusion improved NSTEMI outcomes compared to medical management.
Background:
COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes.
Methods:
We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January-February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January-February 2020; Group 2, n = 124).
Results:
For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001).
Conclusions:
COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.
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