Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI

Abstract

Background The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality. Objectives The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of “at-risk” patient cohorts for failure to present or delays to treatment. Methods This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality. Results A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic. Conclusions The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655 ).

Intensive cardiac care unit admission trends during the COVID-19 outbreak in Italy: a multi-center study

“…We observed a lower mortality for STEMI in the period soon after the end of all containment measures (Table 3), but this observation clearly needs to be investigated in larger studies. Also in terms of time from symptoms onset to hospitalization and PCI rates, we could not find any difference in STEMI population, in contrast to what recently showed in a European registry [26]. The discrepancy regarding mortality may be related to the fact that some studies performed in Italy suggest a different risk in relation to the specific week analyzed and to the geographical area of interest [21]; however, the findings of equal PCI trends during lockdown, and equal presentation times, strenghten the suspicion that the excess of mortality associated to the lockdown period might be dependent from out of hospital deaths.…”

Management of ST Elevation Myocardial Infarction (STEMI) in Different Settings

“…These delays in presentation and treatment led to increased rates of in-hospital mortality. 79,80 Both the AHA/ACC and ESC released statements regarding the management of MI during the COVID-19 pandemic. 81,82 Fibrinolysis has been suggested as an alternative to PCI to reduce potential exposure to cardiac catheterization laboratory staff, but as PCI will eventually be needed in most cases, both statements list primary PCI as the preferred treatment method in patients presenting to PCI-capable hospitals.…”

“…Many centers worldwide reported a decrease in STEMI presentations combined with an increase in door to balloon times. [78][79][80] These changes were thought to be due to patient's reluctance to present to a hospital and delays in care related to increased triage time, COVID testing, and more complex catheterization laboratory protocols. These delays in presentation and treatment led to increased rates of in-hospital mortality.…”

Impact of diabetes in patients waiting for invasive cardiac procedures during COVID-19 pandemic

“…By January 2021, almost 100 million people had suffered the disease, and nearly 2 million have died worldwide. Apart from these direct consequences, health care systems have been severely overwhelmed, negatively impacting on the management of other patients that usually require prompt treatment, especially those with cardiovascular diseases [2][3][4][5][6][7][8]. Specifically, invasive cardiac procedures (ICP) have been cancelled or postponed in many centers, and this may have fatal consequences for some patients, as we have recently shown in a multicenter study from Spain [9].…”