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Impact of COVID-19 Pandemic on Patients with ST-Segment-Elevation Myocardial Infarction Complicated by

Tomasz Tokarek1,2, Artur Dziewierz3,4, Aleksander Zeliaś1

  • 1Center for Invasive Cardiology, Electrotherapy and Angiology, 33-300 Nowy Sacz, Poland.

International Journal of Environmental Research and Public Health
|January 8, 2023
PubMed

Insights

The COVID-19 pandemic prolonged treatment times for ST-segment-elevation myocardial infarction (STEMI) patients with out-of-hospital cardiac arrest (OHCA). However, mortality and complications remained similar, indicating comparable outcomes despite delays in reperfusion.

Area of Science:

  • Cardiology
  • Public Health
  • Emergency Medicine

Background:

  • The COVID-19 pandemic may have impacted emergency medical services and patient care pathways.
  • Concerns exist regarding prolonged reperfusion times for ST-segment-elevation myocardial infarction (STEMI) patients during the pandemic.
  • Out-of-hospital cardiac arrest (OHCA) in STEMI patients presents unique challenges, potentially exacerbated by pandemic-related healthcare access issues.

Purpose of the Study:

  • To investigate the influence of the COVID-19 outbreak on treatment delays in STEMI patients experiencing OHCA.
  • To compare clinical outcomes, including mortality and complications, between STEMI with OHCA patients treated before and during the pandemic.
  • To assess the impact of pandemic conditions on the time from first medical contact to reperfusion therapy.

Main Methods:

  • A retrospective analysis of 5,501 consecutive STEMI patients with OHCA treated with primary percutaneous coronary intervention.
  • Propensity score matching was employed to compare 740 matched pairs of patients treated before and during the COVID-19 pandemic.
  • Key metrics analyzed included time to reperfusion (first medical contact to angiography, pain onset to angiography) and periprocedural outcomes.

Main Results:

  • No significant differences were observed in mortality or periprocedural complications between the pre-pandemic and pandemic groups.
  • Patients treated during the COVID-19 outbreak experienced significantly longer delays from first medical contact to angiography (p=0.006).
  • A trend towards prolonged time from pain onset to angiography was noted in the pandemic era (p=0.06).

Conclusions:

  • Despite increased treatment delays during the COVID-19 pandemic, periprocedural outcomes for STEMI patients with OHCA remained comparable.
  • The findings highlight a significant increase in the time from first medical contact to reperfusion during the pandemic.
  • Further research is needed to understand and mitigate pandemic-related delays in emergency cardiac care.

Keywords:
COVID-19STEMIout-of-hospital cardiac arrest

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