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Updated: Feb 6, 2026
05:26
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
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Impact of COVID-Era Emergency Department Bypass Suspension on ST-Segment Elevation Myocardial Infarction System
Richard Mullvain1, Catherine Benziger1,2, Krysta Kaas1
1From the Department of Cardiology, Essentia Health Heart and Vascular Center, Duluth, MN.
Critical Pathways in Cardiology
|February 5, 2026
Summary
COVID-19 policy changes significantly delayed ST-elevation myocardial infarction (STEMI) reperfusion times in a rural system. Preserving direct emergency medical services (EMS) to catheterization lab pathways is crucial for timely STEMI care.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- The COVID-19 pandemic prompted temporary policy changes affecting emergency medical services (EMS) protocols for ST-elevation myocardial infarction (STEMI) patients.
- Standard emergency department (ED) bypass to the catheterization lab was suspended, requiring COVID testing prior to percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare STEMI system performance metrics during the COVID-era ED routing policy versus pre- and post-pandemic periods.
- To evaluate the impact of altered STEMI pathways on reperfusion times and in-hospital mortality in a rural health system.
Main Methods:
- A retrospective single-center cohort study analyzed consecutive EMS-identified STEMI activations.
- Data were collected across three periods: pre-COVID, COVID-era ED routing, and post-COVID with resumed ED bypass.
- Primary outcomes included standard STEMI system performance metrics; secondary outcome was in-hospital mortality.
Main Results:
- The COVID-era ED routing significantly increased median times for EMS first medical contact to device (13 min), symptom onset to device (30 min), first EMS ECG to device (14 min), and door to device (6 min).
- A non-significant trend toward higher in-hospital mortality was observed during the COVID era.
- A total of 373 patients were included (pre-COVID: 132; COVID: 104; post-COVID: 137).
Conclusions:
- Pandemic-era routing of STEMI patients through the ED resulted in significant delays in critical reperfusion metrics.
- Preserving streamlined STEMI pathways is essential for effective patient care.
- Larger multicenter studies are recommended to further assess outcomes.
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