Outcomes of STEMI Patients in COVID-19 Pandemic: A Systematic Review and Meta-Analysis
Shiva Khaleghparast1, Majid Maleki2, Fereidoun Noohi2
1Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
The COVID-19 pandemic led to worse outcomes for ST-segment elevation myocardial infarction (STEMI) patients, with increased mortality and longer door-to-balloon times. Hospital stays were not significantly affected, but further research is needed.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly strained global health systems.
- Cardiac patients, particularly those with ST-segment elevation myocardial infarction (STEMI), experienced adverse effects due to healthcare prioritization.
- Limited data exists on the in-hospital outcomes for STEMI patients during the pandemic.
Purpose of the Study:
- To systematically review and analyze the in-hospital outcomes of STEMI patients during the COVID-19 pandemic.
- To compare mortality, length of stay, and door-to-balloon times for STEMI patients before and during the pandemic.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, Web of Science, Scopus, Embase) up to January 10, 2021.
- Studies with over twenty participants reporting in-hospital mortality, length of stay, or door-to-balloon time were included, adhering to PRISMA guidelines.
- Meta-analysis was performed to pool data on key outcomes.
Main Results:
- The meta-analysis included 12 studies with 21,170 patients.
- A significant increase in pandemic-related mortality was observed (OR=1.24; 95% CI: 1.07-1.43).
- Door-to-balloon times significantly increased during the pandemic (SMD= 0.46; 95% CI: 0.03-0.89), while length of hospital stay showed no significant change (SMD= 0.04; 95% CI: -0.19-0.26).
Conclusions:
- The COVID-19 pandemic is associated with increased STEMI patient mortality and treatment delays.
- Strict infection control measures during the pandemic may have contributed to these adverse outcomes.
- Longer follow-up studies are recommended to further investigate STEMI patient outcomes.
Background:
The global SARS-CoV-2 pandemic has disrupted health systems and put a huge strain on hospitals and healthcare workers. Prioritizing COVID-19 patients in hospitals caused irreversible harm to cardiac patients. Although multiple studies have shown that ST-segment elevation myocardial infarction (STEMI) patients have worse admission circumstances than before the pandemic, the hospital outcomes of these patients have remained limited. This systematic review and meta-analysis examined STEMI patient outcomes during the COVID-19 epidemic.
Methods:
We conducted systematic searches of MEDLINE (through PubMed), Web of Science, Scopus, and Embase through Jan 10, 2021. All studies with reporting in-hospital mortality, length of stay, and door-to-balloon time with over twenty participants were included. Articles without clear definitions or results were excluded. The study followed PRISMA guidelines. The outcomes of interest were door-to-balloon time, death, and hospital stay during COVID-19 pandemic compared prior.
Results:
Our meta-analysis included 12 studies and 21170 people (115-6609). The pooled analysis showed significantly more pandemic mortality (OR=1.24; 95% CI: 1.07-1.43). Ten studies (13,091) recorded door-to-balloon times. Door-to-balloon time (in minutes) significantly increased during the pandemic (Standardized Mean Difference [SMD]= 0.46; 95% CI: 0.03-0.89). The length of hospital stay was reported by five studies (n=9448). Length of hospital stay (in days) was not significantly longer during the pandemic than before the outbreak (SMD= 0.04; 95% CI: -0.19-0.26).
Conclusion:
The COVID-19 pandemic is associated with increased mortality and door-to-balloon delay that might be attributable to the strict infection control measures in outbreak. Studies with a longer follow-up time are needed to investigate the outcomes of STEMI patients.
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