COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction

Abstract

ObjectiveAlthough there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.MethodsThis single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.ResultsWe analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.ConclusionsFollowing the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.

Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo

“…A previous study from Tokyo revealed that the time course of STEMI management and mortality was comparable before and after the pandemic (9). Another study from Osaka reported similar mortality rates before and after the pandemic, despite an increased incidence of mechanical complications of STEMI (10). However, these studies may have underestimated the impact of the pandemic, as data were limited to the early pandemic period, thereby excluding data from the third and largest wave in Japan; thus, the impact of the COVID-19 pandemic on STEMI patients in Japan remains unclear.…”

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

“…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.…”

Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective

“…Beside this, also lack of or delayed access to reperfusion treatment lead to an increase in short-term ACS complications. In fact, many studies [ 49 , 51 ] described a significant growth in mechanical complications, left ventricular systolic dysfunction, intraventricular thrombus and a higher rate of subsequent CV events (cardiac arrest, cardiogenic shock, and life-threatening arrhythmias).…”