Impact of COVID-19 lockdown on the procedural and intra-hospital outcome of STEMI patients

Abstract

Background While during the COVID-19 pandemic the number of patients presenting with ST-segment elevation myocardial infarction (STEMI) decreased, no change in patient or system delay could be shown due to local lockdown (LD) policy. Not much is known about the influence of LD on procedural details and intrahospital outcome of these patients. Methods Data was obtained from 511 patients treated for acute STEMI (24hours from symptom onset) from January 2019 to March 8th 2021 at two primary PCI (pPCI) centers in Germany. Patients presenting as intra-hospital STEMI, patients showing no culprit lesion and patients undergoing direct CABG were excluded. Overall, 456 patients (74% male, mean age 64±12) were included. These patients were divided into two groups: complete lockdown (LD; n=58; March 21st–April 20th 2020 and December 16th 2020–March 7th 2021) and no complete lockdown (No-LD; n=398)). Results There were no differences in pre-hospital care between the groups: Telemedicine (LD 23.5% vs. No-LD 34.9%; p=0.11), pre-alarm of the cath-lab staff (LD 59.6% vs. 66.6%, p=0.32) and direct admission to the cath-lab (LD 44.8% vs. No-LD 49.8%, p=0.58) were performed as often as in No-LD times. Neither the pain to first medical contact (LD 188±272 Min vs. No-LD 236±317 Min, p=0.29) nor the door to balloon time (55±54 Min vs. No-LD 49±58 Min, p=0.470) as well as other periods showed any difference. All over cardio-pulmonary resuscitation (CPR; LD 19.0% vs. No-LD 14.3%, p=0.35) or presentation with cardiogenic shock (25.9% vs 23.9%, p=0.74) was equally presented in both groups. However, left ventricular assist devices were implanted more often during LD (6.9% vs. No-LD 1.8%; p=0.017). Primary radial access was performed in the majority of the cases (LD 60.3% vs. No-LD 58.8%, p=0.82). During LD the culprit lesion was RCA in most cases (46.6% vs. No-LD LAD 46.7%, p=0.341). Stent thrombosis was not more common in out-of-hospital STEMI patients during LD (6.9% vs. 8.0%, p=0.76). Thrombus aspiration was performed in 10.3% during lockdown (vs. No-LD 4.5%, p=0.06), GP-IIb-IIIa inhibitors were not administered more often (LD 19.0% vs. No-LD 19.4%, p=0.92) and no reflow phenomenon was not seen more frequent (LD 20.7% vs. No-LD 21.3% p=0.91). TIMI III flow could be established in the majority of the cases (LD 86.0% vs. No-LD 91.5%, p=0.20). During further hospital stay, neither the frequency of ventilator (LD 17.2% vs. No-LD 17.0%, p=0.98) nor vasopressor use (LD 20.7% vs. No-LD 20.1% p=0.925) differed. Left ventricular function (47±13% vs. No-LD 45±12%; p=0.34) and maximum creatinkinase (LD 1827±1687 U/l vs. No-LD: 2292±4100 U/l, p=0.40) showed no difference between the groups as did intrahospital death (LD 10.3% vs. No-LD 11.6%, p=0.79). Conclusion Despite the known decline in STEMI patients during LD periods, patient care, procedural details and inta-hospital outcome of the ones presenting to a pPCI hospital do not change during LD periods. FUNDunding Acknowledgement Type of funding sources: None.