Door-to-balloon Time for ST-elevation MI in the Coronavirus Disease 2019 Era

Abstract

In patients presenting with ST-elevation MI, prompt primary coronary intervention is the preferred treatment modality. Several studies have described improved outcomes in patients with door-to-balloon (D2B) and symptom onset-to-balloon (OTB) times of less than 2 hours, but the specific implications of the coronavirus disease 2019 (COVID-19) pandemic on D2B and OTB times are not well-known. This review aims to evaluate the impact of COVID-19 on D2B time and elucidate both the factors that delay D2B time and strategies to improve D2B time in the contemporary era. The search was directed to identify articles discussing the significance of D2B times before and during COVID-19, from the initialization of the database to December 1, 2020. The majority of studies found that onset-of-symptom to hospital arrival time increased in the COVID-19 era, whereas D2B time and mortality were unchanged in some studies and increased in others.

The Impact of Emergency Department Arrival Time on Door-to-Balloon Time in Patients with ST-Segment Elevation Myocardial Infarction Receiving Primary Percutaneous Coronary Intervention

“…During the COVID-19 pandemic, the American College of Cardiology, American College of Emergency Physicians, and Society for Cardiovascular Angiography and Interventions still advocated for PCI as the standard of care for STEMI, performed by expert teams wearing personal protective equipment in dedicated cath labs in hospitals with PCI capabilities [ 30 ]. The effects of the COVID-19 pandemic on DTB times in STEMI patients have been investigated [ 23 , 24 , 25 , 26 , 27 , 31 ]. A systematic review and meta-analysis conducted by Chew et al showed that a significant delay in DTB time was observed during the pandemic, particularly in low-to-middle-income eastern countries [ 31 ].…”

“…To evaluate the net effects of temporal differences (daytime vs. evening vs. nighttime) on a delay in DTB time, logistic regression with a forward-selection Wald test was performed with adjustments for the associated predictors and variables with a p -value < 0.1, as derived from the univariate analysis. The adjusted variables included age [ 10 , 20 , 21 ], sex [ 10 , 20 , 22 ], visits on the weekends [ 11 , 12 , 13 , 15 ], visits during the COVID-19 pandemic [ 23 , 24 , 25 , 26 , 27 ], triage levels [ 7 , 28 ], and the region of infarction [ 10 ]. Additionally, logistic regression with adjustments for the aforementioned variables was carried out for secondary outcomes to determine which period within DTB time was primarily affected by ED arrival time.…”