Impact of COVID-19 pandemic on emergency medical system and management strategies in patients with acute coronary syndrome

Abstract

The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient −0.34, 95% CI −0.50 to −0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26–39] vs. 29 [25–36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic.

Multifaceted Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on ST-Elevation Myocardial Infarction (STEMI): A Literature Review of Incidence, Treatment Modalities, and Outcomes

“…The pre-pandemic era witnessed PCI emerge as one of the best treatment modalities for STEMI patients if door-to-balloon (D2B) time could be maintained <90 minutes. During the early stages of the pandemic, there was an estimated 40% reduction in PCI, an optimal treatment for STEMI, performed in patients [ 34 ]. The total number of hospitalized patients declined by about 26% per week nationally and by about 62% in Hubei province [ 34 ].…”

“…During the early stages of the pandemic, there was an estimated 40% reduction in PCI, an optimal treatment for STEMI, performed in patients [ 34 ]. The total number of hospitalized patients declined by about 26% per week nationally and by about 62% in Hubei province [ 34 ]. With major lockdowns in place and hospitals facing the acute burden of rapidly deteriorating patients, triaging emergent and non-emergent was key to optimizing resource allocation.…”

Global Mapping and Visualization Analysis of One Health Knowledge in the COVID-19 Context

“… 2 The World Health Organization (WHO) declared the COVID-19 outbreak as a global health emergency on January 30, 2020, 3 and on March 11, 2020, it was recognized as a pandemic. 4 6 948 764 deaths and 767 726 861 confirmed cases of COVID-19 have been reported to WHO as of July 7, 2023. 5 The COVID-19 pandemic has resulted in significant social, economic, and political challenges, leaving lasting damage and underscoring the complexity of the situation beyond being solely a health disaster.…”