Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial
Leonard Simoni1, Ilir Alimehmeti2,3, Astrit Ceka4
1Cardiovascular Disease, University Hospital Center "Mother Teresa", Tirana, ALB.
Insights
ST-elevation myocardial infarction (STEMI) admissions and outcomes returned to pre-pandemic levels in 2021, despite the ongoing COVID-19 pandemic. This suggests healthcare systems adapted, maintaining critical care for STEMI patients post-lockdown.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Studies globally and in Albania noted reduced ST-elevation myocardial infarction (STEMI) admissions during the COVID-19 pandemic's initial lockdown.
- Limited research exists on STEMI admissions and outcomes during the pandemic after the initial restrictive measures.
- Understanding trends in STEMI care during the ongoing pandemic is crucial for public health preparedness.
Purpose of the Study:
- To investigate STEMI admissions and in-hospital outcomes in the period following the initial COVID-19 lockdown.
- To compare STEMI patient data from 2021 (ongoing pandemic) with pre-pandemic data from 2019.
Main Methods:
- A retrospective single-center study analyzed consecutive STEMI admissions from March 9th to April 30th, comparing 2019 (pre-pandemic) and 2021 (ongoing pandemic).
- Incidence rate ratios (IRR) were used to compare STEMI admissions and invasive procedures.
- Risk ratios (RR) compared mortality and complication rates between the pre-pandemic and ongoing pandemic periods.
Main Results:
- STEMI admissions in 2021 (234 patients) were similar to 2019 (217 patients), with an IRR of 1.07.
- Invasive procedures, including coronary angiography and percutaneous coronary interventions (PCI), showed similar rates between the two periods.
- STEMI mortality rates were comparable (7.3% in 2021 vs. 7.4% in 2019), with a non-significant trend towards lower primary PCI-related deaths in 2021.
Conclusions:
- Following an initial decline during the 2020 lockdown, STEMI hospitalizations and invasive procedures recovered to pre-pandemic levels in 2021.
- Despite the persistent COVID-19 pandemic, in-hospital mortality for STEMI patients remained stable compared to the pre-pandemic era.
- These findings suggest successful adaptation of healthcare systems in managing STEMI during the ongoing COVID-19 pandemic.
Abstract:
Background Multiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. Methods A retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period. Results The study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions (PCI) [1.09 (0.89-1.34)]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)]. Conclusions After the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.
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