The Impact of the Early COVID-19 Pandemic on ST-Segment Elevation Myocardial Infarction Presentation and Outcomes—A Systematic Review and Meta-Analysis

Abstract

Background: The influence of the early COVID-19 pandemic on non-COVID-19 emergencies is uncertain. We conducted a systematic review and a meta-analysis to evaluate the impact of the first months of the COVID-19 pandemic on the presentation, management, and prognosis of patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We searched the PubMed, Scopus, and Embase databases from January to August 2020. A meta-analysis of studies comparing the profile, STEMI severity at presentation, reperfusion delay, and in-hospital mortality for patients presenting before and during the early COVID-19 pandemic was conducted. Fifteen cross-sectional observational studies including 20,528 STEMI patients from the pre-COVID period and 2190 patients diagnosed and treated during the first months of the COVID-19 pandemic met the inclusion criteria. Results: Patients presenting with STEMI during the pandemic were younger and had a higher comorbidity burden. The time interval between symptoms and first medical contact increased from 93.22 ± 137.37 min to 142 ± 281.60 min (p < 0.001). Door-to-balloon time did not differ significantly between the two periods (p = 0.293). The pooled odds ratio (OR) for low left ventricular ejection fraction at presentation during the pandemic was 2.24 (95% confidence interval (CI) 1.54–3.26) and for a presentation delay >24 h was 2.9 (95% CI 1.54–5.45) relative to before the pandemic. In-hospital mortality did not increase significantly during the outbreak (p = 0.97). Conclusion: During the first months of the COVID-19 pandemic, patients presenting with STEMI were addressed later in the course of the disease with more severe left ventricular impairment. In-hospital emergency circuits and care functioned properly with no increase in door-to-balloon time and early mortality.

Impact of the COVID-19 Pandemic, Stratified by Transfer and COVID-19 Infection Status, on Inpatient Mortality in ST-Elevation Myocardial Infarction Patients, Using a Nationally Representative Database

“…Reasons for the declining incidence of STEMI include stay-at-home orders, a decrease in activities that could trigger STEMI and fear of contracting COVID-19. [13][14][15] Additionally, several studies in European countries observed that the pandemic was associated with a significantly longer ischemia time, including a longer door-to-balloon time and a significant reduction in the number of STEMI patient undergoing PCI. 16,17 Factors associated with delayed management include an increase in transportation time, the need for personal protection equipment and the increased burden on healthcare systems overall.…”

Chronic Obstructive Pulmonary Disease Mortality and Hospitalization during the COVID-19 Pandemic Compared with before the Pandemic: A Systematic Review and Meta-Analysis

“…The crisis triggered a care deficit for non-COVID diseases such as acute myocardial infarction, stroke, out-of-hospital cardiac arrest, and sepsis, with delayed diagnoses and treatments due to enhanced hospital screening procedures. Additionally, there was a marked decrease in hospitalizations for non-COVID-19 diseases [ 4 , 5 , 6 , 7 , 8 ]. This was partially caused by hospitals reallocating resources to handle the spike in COVID-19 cases, and partially because patients delayed or refused treatment for fear of contracting the virus in the healthcare facility [ 9 , 10 ].…”

Comparing the 30-Day Mortality for Hip Fractures in Patients with and without COVID-19: An Updated Meta-Analysis

“…This caused a gap in care for non-COVID-19 diseases, including delays in diagnosis and treatment due to additional screening processes in hospitals and emergency care systems [5]. The pandemic also impacted emergency medical services for diseases such as acute myocardial infarction, stroke, out-of-hospital cardiac arrest, and sepsis [3,4,[6][7][8][9]. During the pandemic, the epidemiological characteristics of known diseases have also changed.…”