Impact of the COVID-19 Pandemic on Door-to-Device Time Segments and Clinical Outcomes for STEMI Patients in Northern
San-Fang Chou1, Chun-Yu Hsieh2, Kuang-Chau Tsai3
1Department of Medical Research.
Insights
The COVID-19 pandemic prolonged Door-to-Device times for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). However, clinical outcomes remained stable, showcasing healthcare system resilience.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- Primary percutaneous coronary intervention (pPCI) is vital for ST-segment elevation myocardial infarction (STEMI) patients.
- The COVID-19 pandemic significantly impacted healthcare delivery globally.
- This study investigates the pandemic's effects on pPCI procedures and outcomes in STEMI patients.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on Door-to-Device (DTD) times for pPCI in STEMI patients.
- To analyze changes in specific DTD time segments during different pandemic phases.
- To evaluate the influence of the pandemic on clinical outcomes of STEMI patients undergoing pPCI.
Main Methods:
- Retrospective, single-center study of STEMI patients undergoing pPCI (February 2019 - January 2022).
- Categorization of the pandemic into three periods: pre-COVID-19, early-pandemic, and epidemic.
- Analysis of DTD time, its components, and clinical outcomes using SPSS.
Main Results:
- Door-to-electrocardiogram (ECG), ECG-to-Cardiac Catheterization Laboratory Activation (CCLA), and CCLA-to-Lab Door times increased in the epidemic period (Period-III).
- Angio-to-Device time decreased during the early-pandemic (Period-II) and epidemic (Period-III) phases.
- Overall DTD time increased in Period-III, but decreased in Period-II. Odds of achieving DTD ≤ 90 minutes decreased by 70% in Period-III.
- Despite DTD time changes, key clinical outcomes (ICU stay, hospital stay, mortality, readmission) remained stable.
Conclusions:
- The COVID-19 pandemic differentially affected segments of the pPCI workflow, influenced by infection control and clinical adaptations.
- The healthcare system demonstrated resilience, maintaining stable clinical outcomes for STEMI patients despite pandemic-related procedural challenges.
Background:
Prompt primary percutaneous coronary intervention (pPCI) is crucial for the prognosis and reduction of myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients. The Coronavirus Disease 2019 (COVID-19) pandemic had multifaceted impacts on healthcare. This study assessed the effects of the pandemic on pPCI procedures and clinical outcomes in emergency STEMI patients.
Methods:
This retrospective, single-center study analyzed STEMI patients who underwent pPCI from February 2019 to January 2022. The COVID-19 pandemic was categorized into three periods: pre-COVID-19 (Period-I), early-pandemic (Period-II), and epidemic (Period-III). The impacts on Door-to-Device time, its segments, and clinical outcomes were analyzed using Statistical Package for the Social Sciences.
Results:
A total of 404 STEMI patients were included, with a reduced number in Period-III. Compared to Period-I, the time intervals of Door-to-electrocardiogram (ECG), ECG-to-Cardiac Catheterization Laboratory Activation (CCLA), and CCLA-to-Cardiac Catheterization Laboratory Door in Period III were extended by 0.62 minutes (p = 0.006), 3.30 minutes (p = 0.009), and 9.65 minutes (p < 0.001), respectively. In contrast, the Angio-to-Device time was shorter in Period- II and III by 2.60 and 4.08 minutes (p < 0.001), respectively. Overall Door-to-Device time increased by 10.06 minutes (p < 0.001) in Period-III but decreased by 3.67 minutes in Period-II (p = 0.017). The odds of achieving a Door-to-Device time ≤ 90 minutes decreased by 70% in Period-III (p = 0.002). Clinical outcomes, including intensive care unit stay, hospital stay, in-hospital mortality, and 30-day readmission rate, remained stable across periods.
Conclusions:
The COVID-19 pandemic had various effects on different segments of the Door-to-Device procedure, and they were influenced by the complex interplay between infection control measures and clinical workflow. The stability of clinical outcomes reflects the resilience and effective adaptations of the healthcare system during the pandemic.
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