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

Abstract

Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.

Angiographic and clinical outcome of SARS-CoV-2 positive patients with ST-segment elevation myocardial infarction undergoing primary angioplasty: A collaborative, individual patient data meta-analysis of six registry-based studies

“…This result might reflect the lower rate of TIMI 0 flow at baseline in SARS-CoV-2 positive patients, but also the heterogeneity in the use of this technique between different catheterization laboratories and registries (in this meta-analysis ranged from 8.6% to 44.0%). The lower use of thrombectomy was reported in the ORPKI Polish national registry [13] and in the international COVID-ACS registry [15] , where thrombectomy was less frequently used in SARS-CoV-2 positive compared with negative control subjects.…”

“…From a total of 1759 reports initially identified, we retrieved 1153 studies through merging of data from independent searches and removing duplicates. During screening and eligibility assessment, we identified 8 articles which fulfilled the criteria of this meta-analysis [ 8 , 11 , [13] , [14] , [15] , [16] , [17] , [18] ]. IPD were provided for 6 out of 8 studies [ 8 , 11 , [13] , [14] , [15] , [16] ] (Supplementary Figure 1 and Supplementary Table 3), encompassing a total of 1711 patients.…”

“…During screening and eligibility assessment, we identified 8 articles which fulfilled the criteria of this meta-analysis [ 8 , 11 , [13] , [14] , [15] , [16] , [17] , [18] ]. IPD were provided for 6 out of 8 studies [ 8 , 11 , [13] , [14] , [15] , [16] ] (Supplementary Figure 1 and Supplementary Table 3), encompassing a total of 1711 patients. Of them, 941 SARS-CoV-2 positive patients were finally included in the quantitative synthesis of data based on the study criteria (Supplementary Figure 2).…”

“…During screening and eligibility assessment, we identified 8 articles which fulfilled the criteria of this meta-analysis [8,11,[13][14][15][16][17][18]. IPD were provided for 6 out of 8 studies [8,11,[13][14][15][16] (Supplementary Fig. 1 and Supplementary Table 3), encompassing a total of 1711 patients.…”

“…Previous studies reported a very high mortality among SARS-CoV-2 positive patients with ST-segment Elevation Myocardial Infarction (STEMI) during hospitalization [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . However, this finding was limited to few reports and small studies with limited power for assessing the indirect (logistic) and direct reasons for the increased mortality in SARS-CoV-2 positive patients.…”