Comparison of Clinical Outcomes in Patients with ST Elevation Myocardial Infarction with Percutaneous Coronary Intervention and the Use of a Telemedicine App Before and After the COVID-19 Pandemic at a Center in Beijing, China, from August 2019 to March 2020

Jiang, Nan; Meng, Shuai; Hu, Hongyu; Chen, Wei; Li, Qun; Zhang, Tong; Song, Ke; Wang, Yang; Jin, Zening

doi:10.12659/msm.927061

Cited by 15 publications

(19 citation statements)

References 41 publications

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“…Among studies that reported clinical presentations, there was a higher proportion of patients with more severe clinical presentations (cardiogenic shock and OHCA) during compared with before the pandemic. 20,24,32,34,42,43,48,59 Patients admitted during the pandemic had less favourable procedural outcomes with a higher proportion of them with post-PCI TIMI < 3 grading, and worse clinical outcomes as evident by higher incidences of MACE, lower LVEF on discharge, and longer ICU stay compared with those admitted before the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…59 As a result, increased mortality and morbidity due to prolonged total ischemic time and associated adverse consequences has been observed in multiple studies. 4,20,21,24,32,36,44,53,57,59 The American College of Cardiology and Society for Cardiovascular Angiography and Interventions still advocate PCI as the main reperfusion strategy for STEMI patients during the pandemic with the same general D2B targets. 2 However, our study showed a significant increase in D2B during the pandemic regardless of the geographical location or income status of a country.…”

Section: Discussionmentioning

confidence: 99%

“…19 O2D time was defined as the time between the onset of symptoms and arrival at the ED of a PCI-capable hospital. [20][21][22][23][24] Study and patient demographic characteristics, procedural outcomes (D2B, post-PCI Thrombolysis In Myocardial Infarction [TIMI] flow grade), and complications data were extracted from included studies. When the mean and SD were not available, estimation of mean and SD was performed using the methods described by Wan et al 25 using the study sample size, median, range, and/or interquartile range.…”

Section: Outcomes and Data Extractionmentioning

confidence: 99%

“…A total of 32 studies met our inclusion criteria. Four studies each originated from China, 4,24,32,33 Italy, 20,[34][35][36] and North America, [37][38][39][40] 3 each from France [41][42][43] and Turkey, [44][45][46] 2 from the United Kingdom, 47,48 and 1 each from Austria, 49 Belgium, 50 Egypt, 51 Iran, 52 Israel, 53 Japan, 54 Pakistan, 55 Poland, 56 Singapore, 23 Spain, 57 and Switzerland. 60 One study was a multicentred cohort study of various databases belonging to different European countries.…”

Section: Summary Of Included Studiesmentioning

confidence: 99%

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The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Chew

Teo

et al. 2021

Canadian Journal of Cardiology

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Background The coronavirus disease-2019 (COVID-19) pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. This review examines the global impact of COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door-to-balloon time (D2B), all-cause mortality and other secondary STEMI outcomes. Methods We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies comparing the aforementioned outcomes between STEMI patients during and before the pandemic. Results In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic respectively. Significant delay in D2B was observed during the pandemic (WMD=8.10mins; CI:3.90-12.30mins; p =0.0002, I 2 =90%). In-hospital mortality was higher during the pandemic (OR=1.27; CI:1.09-1.49; p= 0.002, I 2 =36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis found that low-middle income countries observed a higher rate of mortality during the pandemic (OR=1.52; CI:1.13-2.05; p =0.006), with a similar but insignificant trend seen among the high income countries (OR=1.17; CI:0.95-1.44; p =0.13). Conclusion The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Outcomes and Data Extractionmentioning

confidence: 99%

Section: Summary Of Included Studiesmentioning

confidence: 99%

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The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Chew

Teo

et al. 2021

Canadian Journal of Cardiology

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“…Beijing Tiantan Hospital, Capital Medical University is a local medical referral center in the southwest of Beijing, with 1,650 beds; there are more than 400 out-patient clinic attendances in the Department of Cardiology and Macrovascular Disease per day, with 99 beds (including coronary care unit, CCU). We applied a detailed cardiovascular disease management system, which has been reported elsewhere for non-emergency and emergency medical cares ( 14 , 15 ). In particular, patients without signs of infection and without medical contact history could receive medical service as usual after checking their body temperature.…”

Section: Introductionmentioning

confidence: 99%

Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China

Jiang

Zhang

Tian

et al. 2021

Front. Cardiovasc. Med.

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Background: Knowledge of the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on the performance of a cardiovascular department in a medical referral hub center from a non-epidemic area of China is limited.Method: The data on the total number of non-emergency medical cares (including the number of out-patient clinic attendances, the number of patients who were hospitalized in non-intensive care wards, and patients who underwent elective cardiac intervention procedures) and emergency medical cares [including the number of emergency department (ED attendances) and chest pain center (CPC attendances), as well as the number of patients who were hospitalized in coronary care unit (CCU) and the number of patients who underwent emergency cardiac intervention procedures] before and during the pandemic (time before the pandemic: 20th January 2019 to 31st March 2019 and time during the pandemic: 20th January 2020 to 31st March 2020) in the Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University were collected and compared.Results: Both the non-emergency medical and emergency medical cares were affected by the pandemic. The total number of out-patient clinic attendance decreased by 44.8% and the total number of patients who were hospitalized in non-intensive care wards decreased by 56.4%. Pearson correlation analysis showed that the number of out-patient clinic attendance per day was not associated with the number of new confirmed COVID-19 cases and the cumulative number of confirmed COVID-19 patients in Beijing (r = −0.080, p = 0.506 and r = −0.071, p = 0.552, respectively). The total number of patients who underwent non-emergency cardiac intervention procedures decreased during the pandemic, although there were no statistically significant differences except for patent foramen ovale (PFO) occlusion (1.7 ± 2.9 vs. 8.3 ± 2.3, p = 0.035). As for the emergency medical cares, the ED attendances decreased by 22.4%, the total number of CPC attendances increased by 10.3%, and the number of patients who were hospitalized in CCU increased by 8.9%: these differences were not statistically significant. During the pandemic, the proportion of hospitalized patients with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) significantly increased (19.0 vs. 8.7%, p < 0.001; 28.8 vs. 18.0%, p < 0.001, respectively); also, the number of primary percutaneous coronary intervention (PCI) increased by 10.3%. There was no significant difference between patients before and during the pandemic regarding the age, gender, baseline and discharge medication therapy, as well as length of stay and in-hospital mortality.Conclusions: Our preliminary results demonstrate that both the non-emergency and emergency medical cares were affected by the COVID-19 pandemic even in a referral medical center with low cross-infection risk. The number of the out-patient clinic attendances not associated with the number of confirmed COVID-19 cases could be due to different factors, such as the local government contamination measures. The proportion of hospitalized patients with acute myocardial infarction increased in our center during the pandemic since other hospitals stopped performing primary angioplasty. A hub-and-spoke model could be effective in limiting the collateral damage for patients affected by cardiovascular diseases when the medical system is stressed by disasters, such as COVID-19 pandemic.

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The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review

et al. 2021

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The coronavirus disease 2019 , which is caused by a novel coronavirus (SARS-COV-2), has compromised health care systems and normal management of patients with cardiovascular diseases [1][2][3]. Patients with non-communicable diseases, including acute myocardial infarction (AMI) are vulnerable to this stress [4,5]. Acute ST segment elevation myocardial infarction (STEMI), the most critical type of AMI, is associated with high mortality even with modern medicine [6][7][8]. Timely reperfusion therapy is critical for STEMI patients because a short ischemia time is associated with better clinical outcomes and lower acute and long -term mortality [9][10][11][12]. The COVID-19 pandemic placed the management of STEMI patients in a difficult situation due to the need to balance timely reperfusion therapy and maintaining strict infection control practices [13,14]. Telemedicine, which is used to deliver health care services using information or communication technology, provides an opportunity to carry out the evaluation, diagnosis, and even monitor the patients after discharge when social distancing is needed [15]. In this article, we reported our preliminary experience with the usefulness of telemedicine in managing STEMI patients during the COVID-19 pandemic. We also provided a review of this topic.

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Comparison of Clinical Outcomes in Patients with ST Elevation Myocardial Infarction with Percutaneous Coronary Intervention and the Use of a Telemedicine App Before and After the COVID-19 Pandemic at a Center in Beijing, China, from August 2019 to March 2020

Cited by 15 publications

References 41 publications

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Impact of the 2019 Novel Coronavirus Disease Pandemic on the Performance of a Cardiovascular Department in a Non-epidemic Center in Beijing, China

The Impact of the COVID-19 Pandemic and the Importance of Telemedicine in Managing Acute ST Segment Elevation Myocardial Infarction Patients: Preliminary Experience and Literature Review

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