Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

Abstract

Background: Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have affected management of STEMI. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system. Methods: Four hundred ninety-four patients with STEMI were grouped into prelockdown, lockdown, and reopening cohorts. Clinical, temporal, and outcome data were collected and compared among groups for R ESUM EContexte : La prise en charge de l'infarctus du myocarde avec el evation du segment ST (STEMI) n ecessite une reperfusion rapide. Tout retard de reperfusion prolonge l'isch emie myocardique et augmente le risque de complications, y compris le risque de d ecès. Il est possible que la pand emie de COVID-19 ait nui à la prise en charge du STEMI. Nous avons donc evalu e le nombre relatif d'hospitalisations et le temps ecoul e avant la reperfusion au sein d'un système r egional de traitement des STEMI. M ethodologie : Au total, 494 patients ayant pr esent e un STEMI ont et e divis es en trois cohortes : pr econfinement, confinement et During the COVID-19 pandemic, a reduction in patients presenting with ST-elevated myocardial infarction (STEMI) has been reported. 1,2 These studies lacked data on important areas including impact of the COVID-19 lockdown on STEMI care in regions with low incidence of disease, granular details regarding reperfusion management during lockdown, effect of the pandemic on STEMI care in rural regions, and patterns of STEMI volume posteCOVID-19 lockdown. It is imperative to study the effects of COVID-19 comprehensively, so that lessons can be learned for a potential second wave or future pandemics.From March 11, 2020, to August 16, 2020, the Ottawa regions recorded 2761 cases of In response to the initial outbreak, the Ontario Ministry of Health declared a state of emergency and instituted lockdown measures on March 17, 2020. 4 Various restrictions were imposed including closure of nonessential businesses, limits on social gatherings, and cancellation of elective medical procedures. 4 These interventions were successful in limiting the spread of COVID-19; however, concerns regarding an unintended impact on STEMI care were raised. 3,

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

“…Furthermore, there was a significant increase in time from FMC-to-STEMI diagnosis and FMCto-reperfusion time. These findings point to delays in in-hospital processes related STEMI care J o u r n a l P r e -p r o o f which are supported by a large systematic review and meta-analysis by Rattka et al 10 Similar findings have been previously reported in observational studies around the world, 4,8,9,[14][15][16][17][18][19] including a recently published Canadian study by Clifford et al, who described STEMI care in an Ontario population during the COVID-19 pandemic. 14 Our results were discrepant with previously reported studies as we did not find that there was a significant reduction in patients presenting with STEMI during the COVID-19 pandemic.…”

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.…”

Excess Mortality in Ontario During the COVID-19 Pandemic

“…5,6,13,14 Several studies have shown a significant decline in the number of patients seeking emergency care for cardiac events during the pandemic, citing hesitancy or fear as the main cause. [15][16][17] This trend is supported by data showing that Canadian emergency department volumes dropped by 50% during March and April, 2020. 18 Some of the excess mortality may also be a result of delayed or deferred surgical procedures.…”