Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction
Hyohun Choi1, Jang Hoon Lee1,2, Hyuk Kyoon Park1
1Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
Insights
The COVID-19 pandemic led to fewer acute myocardial infarction (AMI) hospitalizations in Korea. Delays in care and underuse of key medications were observed, potentially increasing mortality for non-STEMI patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Fear of contagion during COVID-19 has been linked to treatment delays and increased mortality in acute myocardial infarction (AMI) patients.
- The impact of the COVID-19 pandemic on time delays and clinical outcomes for ST-segment elevation myocardial infarction (STEMI) and non-STEMI patients in Korea remains under-investigated.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on time delays and clinical outcomes in STEMI and non-STEMI patients.
- To compare these outcomes between the pandemic period and the pre-pandemic era in Korea.
Main Methods:
- Analysis of 598 patients with STEMI or non-STEMI who underwent coronary angiography.
- Comparison between the COVID-19 pandemic period (Feb-Apr 2020) and the pre-pandemic era (Feb-Apr 2017-2019).
- Outcomes assessed included time delays, cardiac arrest incidence, and in-hospital death.
Main Results:
- A 13.5% reduction in AMI hospitalizations was observed during the pandemic.
- STEMI patients showed a trend towards longer door-to-balloon times.
- Non-STEMI patients experienced significantly longer symptom-to-door times, with increased cardiac arrest and in-hospital mortality during the pandemic.
- Underuse of ACE-I/ARBs was noted in both STEMI and non-STEMI patients during the pandemic.
Conclusions:
- The COVID-19 pandemic resulted in reduced AMI hospital admissions, increased time delays, and underutilization of ACE-I/ARBs in Korea.
- These factors may be associated with increased excess deaths during the pandemic.
Background:
It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior.
Methods:
A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death.
Results:
There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic.
Conclusion:
During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.
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