The changes in therapeutic and managerial protocols for patients suffering ST-segment elevation myocardial infarction in COVID-19 pandemic; a systematic review and meta-analysis

Abstract

Introduction: Apart from the direct effect of COVID-19 on the incidence of ischemic heart disease, the pandemic effect of this infection on the control of ischemic heart disease and on the clinical consequences of these patients and also their hospital admission is also significant. Objectives: The present review attempted to assess the admission rate, treatment protocols, and outcome changes in patients suffering ST-segment elevation myocardial infarction (STEMI) in the COVID-19 outbreak. Materials and Methods: The included studies were identified through electronically reviewing the manuscripts databases of MEDLINE, EMBASE, Web of knowledge, and Google Scholar from inception to September 2020. The titles and abstracts of the manuscripts were screened by two blinded reviewers followed by an in-depth assessment of the full texts for assigning the inclusion appropriateness. Results: Eighteen articles (including 6225 STEMI patients hospitalized within the COVID-19 pandemic duration and 55711 STEMI patients in pre-COVID-19 periods) were desirable for the final analysis. A longer delay among symptom onset and first medical contact (FMC) in the COVID-19 lockdown period than before the COVID-19 pandemic was revealed. Comparing STEMI-related death in the COVID-19 period compared to the pre-COVID-19 duration showed a significantly higher death rate and a higher rate of thrombolytic therapy. The examined pre-COVID-19 and COVID-19 periods showed a reduction in STEMI patients’ admissions reached 30.9%. Additionally, entering the COVID-19 period resulted in a significant 44.4% reduction in the number of primary percutaneous coronary intervention. Conclusion: During the COVID-19 pandemic, the management of STEMI has undergone significant changes, including reduced hospital admissions, reduced invasive and semi-invasive treatment interventions, increased STEMI-related mortality, increased thrombolytic therapy, and delayed patients’ referral to the hospitals.