The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

Abstract

Background The coronavirus disease-2019 (COVID-19) pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. This review examines the global impact of COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door-to-balloon time (D2B), all-cause mortality and other secondary STEMI outcomes. Methods We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies comparing the aforementioned outcomes between STEMI patients during and before the pandemic. Results In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic respectively. Significant delay in D2B was observed during the pandemic (WMD=8.10mins; CI:3.90-12.30mins; p =0.0002, I 2 =90%). In-hospital mortality was higher during the pandemic (OR=1.27; CI:1.09-1.49; p= 0.002, I 2 =36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis found that low-middle income countries observed a higher rate of mortality during the pandemic (OR=1.52; CI:1.13-2.05; p =0.006), with a similar but insignificant trend seen among the high income countries (OR=1.17; CI:0.95-1.44; p =0.13). Conclusion The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.

Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic

“…However, decline in the number of patients with STEMI was detected immediately after COVID-19 outbreak with analogical outcomes in rural areas. Thus, the effect of air quality seems to be negligible [10,25]. Similarly, the previous study suggested a two-fold increase in stress index level in the population during the lockdown.…”

“…To the best of our knowledge, we present the first national registry of STEMI treatment depending on the time of PCI during the COVID-19 pandemic. Several studies have confirmed the reduced number of STEMI patients regardless of geographical location [1][2][3][10][11][12][22][23][24][25]. Some authors have pointed out lower air pollution or less work-related stress during the lockdown [2,10,12].…”

“…Several studies have confirmed the reduced number of STEMI patients regardless of geographical location [1][2][3][10][11][12][22][23][24][25]. Some authors have pointed out lower air pollution or less work-related stress during the lockdown [2,10,12]. However, decline in the number of patients with STEMI was detected immediately after COVID-19 outbreak with analogical outcomes in rural areas.…”

“…Furthermore, pandemic-specific protocols require additional time to prepare medical staff and the catheterization laboratory before the procedure [1][2][3][4]. Thus, patients with STEMI might be exposed to longer delays for angiography with revascularization and increased risk of death [4,[8][9][10][11][12]. Furthermore, some data suggest additional treatment delay for PCIs performed during off-hours [13,14].…”

“…These agents might be linked with a higher rate of bleeding and vascular complications [5,6]. However, current reports emphasize hypercoagulability and high thrombus burden with potentially detrimental outcomes in patients with STEMI and COVID-19 diagnosis [8][9][10][11][12]. Irrespective of the exponential growth of evidence, there are still limited data on the clinical outcomes in STEMI with diagnosed COVID-19.…”