COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction

Abstract

Background The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate. Methods Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019. Results A total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797). Conclusions During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations.

Frequency and prognosis of CVD and myocardial injury in patients presenting with suspected COVID-19 – The CoV-COR registry

“…Importantly, cardiovascular disease was identified as the underlying cause for symptoms suggestive of COVID-19 in 40% of COVID-19 negative patients, underlining the clinical similarities of both disease entities. In line with existing literature, the comparable prevalence of myocardial injury as well as 90-day mortality in irrespective of COVID-19 infection underlines the need for early screening for cardiovascular diseases in all patients presenting with symptoms suggestive of COVID-19 infection to detect patients with impaired prognosis [22] . Interestingly, we observed a higher frequency of myocardial injury in COVID-19 negative vs. positive patients, which stresses the need for the screening for cardiovascular causes in patients presenting with symptoms suggesting a COVID infection, even during a pandemic.…”

The Influence of SARS-CoV-2 Infection on Acute Myocardial Infarction Outcomes

“…COVID-19 can cause heart muscle inflammation and injury in an MI-independent manner. At the health care system level, COVID-19 may perturb acute coronary syndrome hospitalization pathways, thus decreasing the rate of MI hospitalizations [ 3 , 4 , 5 , 6 , 7 , 8 , 9 ] worldwide, delaying patients’ contact with medical services [ 10 , 11 , 12 ] and emergency department arrival times of patients with suspected acute coronary syndrome [ 13 ] and increasing the door-to-balloon time [ 14 , 15 , 16 ], scar size (as confirmed with cardiac magnetic resonance) [ 17 ], and rate of mechanical complications. Moreover, during the COVID-19 pandemic, the prolongation of time from the first medical contact to revascularization was revealed in a group of patients with STEMI and out-of-hospital cardiac arrest [ 18 ].…”

Profile trends of non-COVID patients admitted to the cardiac intensive care unit during the 2020 COVID pandemic

“…We believe that these trends result from patients deferring to seek medical care, possibly influenced by several factors such as mental status, economic considerations, social factors, concerns related to government decisions and limitations, and fear of being infected with COVID-19. 10 , 11 , 12 Under the influence of such factors, the delay in seeking medical care may lead to preventable and unnecessarily poor outcomes for non-COVID patients.…”