Centralization of the ST elevation myocardial infarction care network in the Lombardy region during the COVID-19 outbreak

Ferlini, Marco; Andreassi, Aida; Carugo, Stefano; Cuccia, Claudio; Bianchini, B; Castiglioni, Battistina; Urbano, Maurizio D'; Guagliumi, Giulio; Lettino, Maddalena; Marenzi, Giancarlo; Metra, Marco; Migliori, Maurizio; Montorfano, Matteo; Oliva, Fabrizio; Savonitto, Stefano; Seregni, Romano; Visconti, Luigi Oltrona

doi:10.1016/j.ijcard.2020.04.062

Cited by 13 publications

(14 citation statements)

References 5 publications

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“… 18–20 Acentralized and specific “Hub” is also demonstrated to be effective to perform PPCI when the systemic delay is not significantly prolonged. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

“…[18][19][20] Acentralized and specific "Hub" is also demonstrated to be effective to perform PPCI when the systemic delay is not significantly prolonged. 21,22 Beijing Tiantan Hospital applied different RT for STEMI patients during the COVID-19 pandemic according to the overall risk of cross-infection. When the overall risk of cross-infection was relatively low in our hospital, we applied PPCI after STEMI patents finished the screening protocol.…”

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confidence: 99%

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Fibrinolysis Therapy Combined with Deferred PCI versus Primary Angioplasty for STEMI Patients During the COVID-19 Pandemic: Preliminary Results from a Single Center

Jiang¹,

Meng²,

Hu³

et al. 2021

IJGM

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Introduction:The efficacy of fibrinolysis therapy with deferred percutaneous coronary angioplasty (FPCI) versus primary angioplasty (PPCI) during the coronavirus disease 2019 (COVID-19) pandemic is unclear when medical quarantine is needed. Patients and Methods: Acute ST segment elevation myocardial infarction (STEMI) patients underwent PPCI after finishing the screening protocol from January 23, 2020 to June 10, 2020 while FPCI was applied when COVID-19-confirmed cases reoccurred in Beijing near our hospital from June 11, 2020 to July 20, 2020. The door-to-balloon time (DTB) or door-to-needle time (DTN) as well as in-hospital adverse clinical outcomes were compared between the two groups. A propensity score-matched (PSM) analysis was performed to diminish the potential influence of confounding factors on the clinical outcomes. Results: A total of 126 STEMI patients underwent PPCI after finishing the screening protocol and 17 patients received FPCI before PSM. Patients who received FPCI were younger than patients who underwent PPCI (50.8±14.0 versus 64.1±14.2 years, p=0.001), and chronic kidney disease (CKD) was less common in FPCI patients than in patients who underwent PPCI (0% versus 24.6%, p=0.024). The DTN was significantly shorter than DTB (25.8±4.2 versus 61.1 ±10.7, p=0.000) before PSM. The DTN was significantly shorter than DTB (26.9±4.2 versus 64.9±23.6, p=0.000); however, the incidence rate of in-hospital ischemia and bleeding adverse clinical outcomes were comparable between the two groups after PSM. Conclusion: Fibrinolysis therapy combined with deferred PCI can reduce the ischemia time and has a similar in-hospital adverse clinical outcome rate compared with patients who underwent primary PCI during the COVID-19 pandemic.

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“… 18–20 Acentralized and specific “Hub” is also demonstrated to be effective to perform PPCI when the systemic delay is not significantly prolonged. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Fibrinolysis Therapy Combined with Deferred PCI versus Primary Angioplasty for STEMI Patients During the COVID-19 Pandemic: Preliminary Results from a Single Center

Jiang¹,

Meng²,

Hu³

et al. 2021

IJGM

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“…The delay on STEMI reperfusion during the COVID-19 pandemic has been explained by the fact that the emergency medical system was focused on COVID-19 and a large number of healthcare workers was relocated to manage the pandemic, resulting in increased mortality and complications in STEMI patients [ 6 , 14 , 15 ]. In contrast, the delay of STEMI care was minimal in our center, suggesting that the healthcare system effectiveness was maintained despite the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic

Matsushita

Hess

Marchandot

et al. 2020

J Thromb Thrombolysis

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Although a reduction in hospital admissions of acute coronary syndromes (ACS) patients has been observed globally during the coronavirus disease 2019 (COVID-19) pandemic, clinical features of those patients have not been fully investigated. The aim of the present analysis is to investigate the incidence, clinical presentation, and outcomes of patients with ACS during the COVID-19 pandemic. We performed a retrospective analysis of consecutive patients who were admitted for ACS at our institution between March 1 and April 20, 2020 and compared with the equivalent period in 2019. Admissions for acute myocardial infarction (AMI) reduced by 39.5% in 2020 compared with the equivalent period in 2019. Owing to the emergency medical services (EMS) of our region, all time components of ST-elevated myocardial infarction care were similar during the COVID-19 outbreak as compared with the previous year’s dataset. Among the 106 ACS patients in 2020, 7 patients tested positive for COVID-19. Higher incidence of type 2 myocardial infarction (29% vs. 4%, p = 0.0497) and elevated D-dimer levels (5650 μg/l [interquartile range (IQR) 1905–13,625 μg/l] vs. 400 μg/l [IQR 270–1050 μg/l], p = 0.02) were observed in COVID-19 patients. In sum, a significant reduction in admission for AMI was observed during the COVID-19 pandemic. COVID-19 patients were characterized by elevated D-dimer levels on admission, reflecting enhanced COVID-19 related thrombogenicity. The prehospital evaluation by EMS may have played an important role for the timely revascularization for STEMI patients. Electronic supplementary material The online version of this article (10.1007/s11239-020-02340-z) contains supplementary material, which is available to authorized users.

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“…Parallel to this, in our study, PI-WSUR total score and PI-WSUR C-OCD were higher in the period of 20 March to 20 April compared to the period of 20 May to 20 June (37 (27–63) IQR, 25 (15–44) IQR, P = 0.045; 21 (11−32) IQR, 11 (5–24) IQR, P < 0.001, respectively) (Table-1). The effect of contamination fear on hospital admission time has been speculated in many studies, but it has not been studied comprehensively so far [ [21] , [22] , [23] , [24] , [25] , [26] ]. As far as the researchers investigated, this is the first study which evaluates the association between contamination fear and prehospital delay during the COVID-.…”

Section: Discussionmentioning

confidence: 99%

Temporal association of contamination obsession on the prehospital delay of STEMI during COVID-19 pandemic

Karagöz

Keskin

Kültürsay

et al. 2021

The American Journal of Emergency Medicine

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Centralization of the ST elevation myocardial infarction care network in the Lombardy region during the COVID-19 outbreak

Cited by 13 publications

References 5 publications

Fibrinolysis Therapy Combined with Deferred PCI versus Primary Angioplasty for STEMI Patients During the COVID-19 Pandemic: Preliminary Results from a Single Center

Fibrinolysis Therapy Combined with Deferred PCI versus Primary Angioplasty for STEMI Patients During the COVID-19 Pandemic: Preliminary Results from a Single Center

Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic

Temporal association of contamination obsession on the prehospital delay of STEMI during COVID-19 pandemic

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