ST-Segment–Elevation Myocardial Infarction Care and COVID-19

Bainey, Kevin R.; Bates, Eric R.; Armstrong, Paul W.

doi:10.1161/circoutcomes.120.006834

Cited by 17 publications

(4 citation statements)

References 5 publications

(3 reference statements)

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“…Pertaining to STEMI care, first medical contact is essential to ensure quality metrics for delivery of care and targeting clinical decisions, and not merely the in-hospital door to balloon time. While a focus on using prehospital time metrics is essential, a rigorous study of quality measures in-hospital processes is recommended (2,5). The best outcomes are linked to ensuring that the first medical contact and treatment delay is shortened.…”

Section: Resultsmentioning

confidence: 99%

“…This is a leading cause of delay for times of STEMI emergency reperfusion. A modulation of US intervention care is essential for catheterization laboratory protocols (4,5). Based on Sichuan's experiences, a protocol may be adopted for patients who are at high risk or confirmed cases of COVID-19 to visit the laboratory on a case-bycase basis.…”

Section: Brief Communicationmentioning

confidence: 99%

“…Based on Sichuan's experiences, a protocol may be adopted for patients who are at high risk or confirmed cases of COVID-19 to visit the laboratory on a case-bycase basis. STEMI rates have reduced during the COVID-19 pandemic, partly due to the lack of access to emergency departments or risking hospital exposure (5,6). The hindrances to PCI are tripartite.…”

Section: Brief Communicationmentioning

confidence: 99%

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COVID-19 and Primary Percutaneous Coronary Intervention (PCI): Delayed Presentations and Outcomes for STEMI care

Sarfraz

et al. 2024

Int J Front Sci

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Primary percutaneous coronary intervention (PPCI) is a non-surgical procedure that requires catheterization to improve blood flow to the heart and is the recommended therapy for Acute Myocardial Infarction (AMI). The Coronavirus 2019 (COVID-19) pandemic has altered the course of reperfusion therapy for patients with ST-elevation myocardial infarction (STEMI). It is imperative to emphasize the awareness of timely PCI and the effects it has on improving patient outcomes. Based on the consensus statement by the American College of Cardiology (ACC), American College for Emergency Physicians (ACEP), and the Society for Cardiovascular Angiography and Interventions (SCAI), it is critical to inform the public to call the emergency medical system for AMI symptoms and obtain the appropriate level of care. Ultimately, COVID-19 has posed unprecedented challenges to public health. The immediate threat is linked to morbidity and mortality related to the infection, and the masked threat is the waning attention and resources utilized for the care of other diseases. First medical contact is the main time target, and reducing treatment delays to improve patient outcomes in AMI patients with STEMI should be the next immediate objective in healthcare systems worldwide.

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Section: Resultsmentioning

confidence: 99%

Section: Brief Communicationmentioning

confidence: 99%

Section: Brief Communicationmentioning

confidence: 99%

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COVID-19 and Primary Percutaneous Coronary Intervention (PCI): Delayed Presentations and Outcomes for STEMI care

Sarfraz

et al. 2024

Int J Front Sci

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“…Additionally, the transfer of patients from the ER to the cath lab is complicated by the risk of staff exposure and delays associated with preparing personal protective equipment. 14 This observation also reflects the shortage of available physicians, nurses and auxiliary personnel. 15 Contrary to findings from a multicentre study, the time of patient arrival during office and non-office hours did not significantly contribute to delays.…”

Section: Discussionmentioning

confidence: 99%

System Delays and Target Points: An Analysis of the ST-elevation MI Response Programme in a Single Centre

Toledano

Garganera

Prado

et al. 2023

J Asian Pac Soc Cardiol

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Background: The goal in the treatment of ST-elevation MI (STEMI) is prompt revascularisation. This study aims to assess system delays and identify optimal target points within each step of the response program. Methods: This study included adults aged >19 years enrolled in the acute MI (AMI) registry due to STEMI and treated with emergency percutaneous coronary intervention (PCI) between January 2019 and June 2021. Door-to-balloon times and STEMI diagnosis-to-wire cross times were divided into Met and Unmet groups, and time frames were compared using the Mann–Whitney U-test. For time frames with no significant difference, the median of the Met group was adopted, whereas, for significantly different time frames, the optimal target points were chosen from the highest percentages of Met if the value was less than or equal to the target point and Unmet if the value was greater than the target point. ORs with 95% CIs from binary logistic regression were calculated to predict the Met status. Results: In all, 113 participants were analysed. Significant delays were observed in ECG to paging (p≤0.034), cardiology fellow on duty (CFOD) arrival to STEMI diagnosis (p=0.008), STEMI diagnosis to consent (p≤0.001), consent to cath lab (p≤0.001) and cath lab to puncture (p=0.003). The optimal targets in minutes were as follows: door to ECG (≤9 median), ECG to paging (≤1, OR 2.19, p=0.069), paging to CFOD arrival (≤2 median), CFOD arrival to STEMI diagnosis (≤3, OR 2.15, p=0.086), STEMI diagnosis to consent (≤10, OR 7.57, p≤0.001), consent to cath lab (≤24, OR 15.38, p≤0.001), cath lab to puncture (≤12, OR 2.68, p≤0.043). Conclusion: In a developing country and during the COVID-19 pandemic, the most significant delays in our STEMI programme occurred in obtaining consent for emergency PCI and transferring patients to the cath lab. Optimal target points for each time frame can provide concrete objectives that may increase the likelihood of achieving door-to-balloon time and STEMI diagnosis to wire cross goals.

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STEMI care 2021: Addressing the knowledge gaps

Yıldız

Wade

Henry

2021

American Heart Journal Plus: Cardiology Research and Practice

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Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care.

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ST-Segment–Elevation Myocardial Infarction Care and COVID-19

Cited by 17 publications

References 5 publications

COVID-19 and Primary Percutaneous Coronary Intervention (PCI): Delayed Presentations and Outcomes for STEMI care

COVID-19 and Primary Percutaneous Coronary Intervention (PCI): Delayed Presentations and Outcomes for STEMI care

System Delays and Target Points: An Analysis of the ST-elevation MI Response Programme in a Single Centre

STEMI care 2021: Addressing the knowledge gaps

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