Association of the COVID-19 Pandemic on Treatment Times for ST-Elevation Myocardial Infarction: Observations from the
David M Shavelle1, Nichole Bosson2, William J French3
1Memorial Care Heart and Vascular Institute, Long Beach Medical Center, Long Beach, California.
Insights
During COVID-19, ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) had shorter treatment times but similar outcomes. Mature cardiac systems maintained efficient STEMI care despite pandemic challenges.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Previous studies indicated longer treatment times and worse outcomes for ST-elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic.
- The pandemic presented unique challenges to healthcare systems, potentially impacting the timely delivery of critical cardiac interventions.
Purpose of the Study:
- To evaluate the impact of the COVID-19 pandemic on treatment times and clinical outcomes for STEMI patients undergoing primary PCI within a large regional care system.
- To compare key performance indicators and patient outcomes between the COVID-19 pandemic period and a pre-pandemic control period.
Main Methods:
- Retrospective analysis of data from the Los Angeles County Emergency Medical Services Agency for STEMI patients (≥18 years) undergoing emergent coronary angiography.
- Data were abstracted for two periods: March 19, 2020, to January 31, 2021 (during COVID-19) and the same interval the previous year (control).
- Primary endpoint was first medical contact (FMC) to device time; secondary endpoints included treatment intervals, complications, need for bypass surgery, hospital stay, and mortality.
Main Results:
- A total of 3,017 patients underwent angiography for STEMI (1,124 during COVID-19, a 40% decrease).
- FMC to device time was significantly shorter during the COVID-19 period (median 77.0 vs. 81.0 minutes, p=0.004), while PCI rates were slightly lower (75.1% vs. 78.7%).
- Outcomes including vascular complications, need for emergent bypass surgery, length of hospital stay, and in-hospital mortality were similar between the two periods.
Conclusions:
- In a large regional system, STEMI patients treated during the COVID-19 pandemic experienced a small but significant decrease in treatment times with overall similar clinical outcomes compared to the pre-pandemic period.
- These findings suggest that established cardiac systems of care demonstrated resilience and maintained efficient STEMI treatment delivery despite the challenges posed by the COVID-19 pandemic.
Abstract:
Previous studies have documented longer treatment times and worse outcomes for patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic. The objective of the present study was to evaluate the impact of the COVID-19 pandemic on treatment times and outcomes for patients with STEMI who underwent primary PCI within a regional system of care. This was a retrospective study using data from the Los Angeles County Emergency Medical Services Agency. Data on the emergency medical service activations were abstracted for patients with STEMI from March 19, 2020 to January 31, 2021, during the COVID-19 pandemic and for the same interval the previous year. All adult patients (≥18 years) with STEMI who underwent emergent coronary angiography were included. The primary end point was the first medical contact (FMC) to device time. The secondary end points included treatment time intervals, vascular complications, need for emergent coronary artery bypass surgery, length of hospital stay, and in-hospital mortality. During the study period, 3,017 patients underwent coronary angiography for STEMI, 1,893 patients pre-COVID-19 and 1,124 patients during COVID-19 (40% lower). A total of 2,334 patients (77%) underwent PCI. During the COVID-19 period, rates of PCI were significantly lower compared with the control period (75.1% vs 78.7%, p = 0.02). FMC to device time was shorter during the COVID-19 period compared with the control period (median 77.0 vs 81.0 minutes, p = 0.004). For patients with STEMI complicated by out-of-hospital cardiac arrest, FMC to device time was similar during the COVID-19 period compared with the control period (median 95.0 [33.0] vs 100.0 [40.0] minutes, p = 0.34). Vascular complications, the need for emergent bypass surgery, length of hospital stay, and in-hospital mortality were similar between the periods. In conclusion, in this large regional system of care, we found a relatively small but significant decrease in treatment times, yet overall, similar clinical outcomes for patients with STEMI who underwent primary PCI and were treated during the COVID-19 period compared with a control period. These findings suggest that mature cardiac systems of care were able to maintain efficient care despite the challenges of the COVID-19 pandemic.
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