Care and Outcomes of ST-Segment Elevation Myocardial Infarction Across Multiple COVID-19 Waves

Malhi, Navraj; Moghaddam, Nima; Hosseini, Farshad; Singer, Joel; Lee, Terry; Turgeon, Ricky D.; Wong, Graham C.; Fordyce, Christopher B.

doi:10.1016/j.cjca.2022.01.033

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…The release of measures was associated also with the “normalization” of people’s health behavior. Mahli et al [ 20 ] in Canada studied STEMI care across multiple waves of COVID1-19 during 2020 observing similar incidences of STEMI during and before the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…The peak of documented active cases during the years 2020-2021 was on March 5th 2021 by 1278.36 /100000 inhabitants demonstrating that the COVID-19 pandemic severely hit the country by that time [16]. Throughout the ongoing pandemic, many countries undertook many other restrictive measures, and closures and also installed other periods of total lockdown with various effects on hospitalizations and outcomes of patients with ACS [(STEMI and Non-ST-elevation acute coronary syndromes (NSTEACS)] [17][18][19][20][21][22][23][24]. Based on our first report for STEMI admissions and outcomes during the lockdown COVID-19 period [15], our purpose was to investigate the admissions and in-hospital outcomes during the same timeframe throughout the ongoing pandemic period in 2021.…”

Section: Introductionmentioning

confidence: 99%

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Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study

Simoni¹,

Alimehmeti²,

Ceka³

et al. 2022

Cureus

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BackgroundMultiple studies conducted worldwide and in Albania documented an important reduction of acute STelevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. MethodsA retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30 th , the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period. ResultsThe study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions ]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)]. ConclusionsAfter the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study

Simoni¹,

Alimehmeti²,

Ceka³

et al. 2022

Cureus

View full text Add to dashboard Cite

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“…Our group has previously examined the effects of the COVID-19 pandemic on STEMI outcomes and found that within our health authority, there were delays in reperfusion during the COVID-19 pandemic compared with the historical control. 29 These delays would be reflected in a small percentage of our dataset. Table S11 shows mortality rate by shock, FMC-to-device time, and year during the course of the study.…”

Section: Discussionmentioning

confidence: 96%

Reperfusion Delays and Outcomes Among Patients With ST-Segment–Elevation Myocardial Infarction With and Without Cardiogenic Shock

Kochan,

Lee,

Moghaddam

et al. 2023

Circ: Cardiovascular Interventions

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Background: Mortality remains high in patients with ST-segment–elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS), and early reperfusion has been shown to improve outcomes. We analyzed the association between first medical contact (FMC)-to-percutaneous coronary angiography time with mortality and major adverse cardiovascular events among patients with STEMI with and without CS. Methods: We performed a retrospective analysis of the Vancouver Coastal Health Authority STEMI registry, including all patients with STEMI who received primary percutaneous coronary angiography between January 1, 2010, and December 31, 2020, and stratified them by presence or absence of CS at hospital arrival. The primary outcome was in-hospital mortality, the secondary outcome was in-hospital major adverse cardiovascular events, defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, intracerebral hemorrhage, cerebrovascular accident, or reinfarction. Mixed effects logistic regression with restricted cubic splines was used to estimate the relationships between FMC-to-device time and the outcomes in the CS and non-CS groups. Results: 2929 patients were included, 9.4% (n=275) had CS. Median FMC-to-device time was 113.5 (interquartile range, 93.0–145.0) and 103.0 (interquartile range, 85.0–130.0) minutes for patients with CS and without CS, respectively. More patients with CS had FMC-to-device times above guideline recommendations (76.6% versus 54.1%, P <0.001). Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, absolute mortality for patients with CS increased by 4% to 7%, whereas for patients without CS, it increased by <0.5%. Conclusions: Among patients with STEMI undergoing primary percutaneous coronary angiography, reperfusion delays among patients with CS are associated with significantly worse outcomes. Strategies to reduce FMC-to-device times for patients with STEMI presenting with CS are required.

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“…Some studies point to an increase in AMI-time delays, less access to standard care and worse short-term outcomes of AMI pts admitted during COVID-19 pandemic [5][6][7][8][9][10][11][12]. Focusing time-delays, it has even been described a continuous increase in such delays through COVID-19 waves [13]. Still, other published studies describe distinct data, where time-delays do not seem to be affected by the pandemic [14] and, even a decreased door-to-balloon time has been reported in the context of ST-elevation myocardial infarction (STEMI) [15].…”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes

Marques¹,

Cabrita²,

Araújo³

et al. 2023

Monaldi Arch Chest Dis

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COVID-19 pandemic has unquestionably influenced care of acute myocardial infarction (AMI). Still, its impact on patients (pts) characteristics, presentation, treatment, and outcomes remains not well established in late pandemic times. To address this issue, we performed a prospective study of type-1 AMI pts admitted in a tertiary care hospital. Pts were enrolled during 6-months in 2019 (n=122; pre-COVID-19 (PC) group) and in 2021 (n=196; late-COVID-19 (C) group). Data was based on pts interview and review of medical records. Age and gender distribution, as well as ST/Non-ST-Elevation Myocardial Infarction (STEMI/NSTEMI) proportion and access to coronariography and revascularization were similar between groups. C pts presented more pre-existing established cardiovascular disease (CVD) (43% vs 30%; p=0,03); more frequent description of typical chest pain (94% vs 84%; p=0,002); higher levels of pain intensity, in a 0-10 scale (8±2 vs 7±2; p=0,02); higher frequencies of AMI complications (27% vs 15%; p=0,01) and worse Killip (K) class evolution (K≥2 in 22% C vs 13% PC pts; p=0,05). In conclusion, late pandemic AMI pts presented worse in-hospital outcomes in our study, though pre-hospital and hospital care were comparable to pre-pandemic times. Covid pts had a higher burden of pre-existing established CVD and a more typical and intense symptom presentation. Therefore, it can be hypothesized that "sicker" pts continued to look for help when presenting AMI symptoms, while "less sick" pts and the ones with less typical and intense symptoms possibly avoided contact with health care services during late pandemic period.

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Care and Outcomes of ST-Segment Elevation Myocardial Infarction Across Multiple COVID-19 Waves

Cited by 5 publications

References 25 publications

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study

Reperfusion Delays and Outcomes Among Patients With ST-Segment–Elevation Myocardial Infarction With and Without Cardiogenic Shock

Acute myocardial infarction during late COVID-19 era: patient characteristics, presentation and outcomes

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