Impact of the SARS-CoV-2 Pandemic on Primary Percutaneous Coronary Intervention for Patients with ST-Elevation Myocardial Infarction

Abstract

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with STelevation myocardial infarction (STEMI) should be treated as possibly infected individuals. Therefore, more time is considered necessary to conduct primary percutaneous coronary intervention (PCI). In this study, we sought to evaluate the impact of the SARS-CoV-2 pandemic on primary PCI for STEMI. Between March 2019 and March 2021, 259 patients with STEMI underwent primary PCI. Patients were divided into 2 groups: the pre-pandemic group (March 2019-February 2020) and the pandemic group (March 2020-February 2021). The patient demographics, reperfusion time including onset-to-door time, door-to-balloon time (DTBT), computed tomography (CT), peak creatinine phosphokinase (CPK), and 30-day mortality rate were investigated. The mean age of the patients was 70.4 ± 12.9 years, and 71.6% were male. There were 117 patients before the pandemic and 142 during the pandemic. The median DTBT was 29 (21.25-41.25) minutes before the pandemic and 48 minutes (31-73 minutes) during the pandemic (P < 0.001). The median door-to-catheter-laboratory time was 13.5 (10-18.75) minutes before the pandemic and 29.5 (18-47.25) minutes during the pandemic (P < 0.001). CT evaluation was performed before PCI in 39 (33.3%) patients and 63 (44.4%) patients (P = 0.08); their peak CPK levels were 1480 (358-2737.5) IU and 1363 (621-2722.75) IU (P = 0.56), and the 30-day mortality rates were 4.3% and 2.1% (P = 0.48), respectively. The SARS-CoV-2 pandemic changed the diagnostic procedure in the emergency department and affected the DTBT in patients with STEMI. Nonetheless, no adverse effects on the 30-day mortality rate were observed.

Impact of the COVID-19 pandemic on the hospitalizations, time course, presenting symptoms, and mid-term outcomes in patients with myocardial infarctions in a Japanese multi-center registry

“…In the present study, the DTBT was significantly longer and 180-day mortality numerically (but not significantly) greater in the after-pandemic period than the pre-pandemic period, which was consistent with the previous Japanese reports [ 3 – 5 ]. On the other hand, the results outside of Japan have shown an increase in the mortality from AMIs in the after-pandemic period [ 18 – 20 ].…”

“…Several studies from Japan have reported a significantly longer time of the door-to-balloon time (DTBT), while the short-term mortality has been preserved after the COVID-19 pandemic as compared to that before the pandemic in patients with ST-elevation myocardial infarctions (STEMIs) [ 3 – 5 ]. As for the patients with non-ST-elevation myocardial infarctions (NSTEMIs), there are few Japanese data focusing on investigating the impact of the COVID-19 pandemic.…”

Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review

“…While direct clinical outcomes related to COVID-19, such as case incidence rate, mortality, and morbidity, have been closely tracked; the indirect effects of the pandemic are multifactorial and less clearly established. Various reports and previous studies have demonstrated that the public fear regarding contracting the virus, especially in early stages of the pandemic, resulting in decreased utilization of emergency medical services [ 12 , 37 , 38 ]. Other studies have reported significant delays in acute care for a variety of emergent medical conditions, such as stroke and STEMI [ [41] , [42] , [43] , [44] , [45] ].…”

Takotsubo syndrome before and during the COVID‐19 pandemic in Austria: a retrospective cohort study (TOSCA‐19)

“…However, the in‐hospital prognosis of ACS patients during the COVID‐19 pandemic was worse than that of TTS patients. The reason for this difference may be later presentation after the onset of symptoms in ACS patients during the pandemic, which led to worse outcome 39–42 . On the other hand, the risk profile of patients presenting with TTS did not change during the COVID‐19 pandemic, resulting in a stable short‐term outcome.…”