Effect of the COVID-19 Pandemic on Treatment Delays in Patients with ST-Segment Elevation Myocardial Infarction.
Sebastian Johannes ReinstadlerMartin ReindlIvan LechnerMagdalena HolzknechtChristina TillerFranz Xaver RoithingerMatthias FrickUta C HoppePeter JirakRudolf BergerGeorg Delle-KarthElisabeth LaßnigGert KlugAxel BauerRonald BinderBernhard MetzlerPublished in: Journal of clinical medicine (2020)
Coronavirus disease 19 (COVID-19) and its associated restrictions could affect ischemic times in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to investigate the influence of the COVID-19 outbreak on ischemic times in consecutive all-comer STEMI patients. We included consecutive STEMI patients (n = 163, median age: 61 years, 27% women) who were referred to seven tertiary care hospitals across Austria for primary percutaneous coronary intervention between 24 February 2020 (calendar week 9) and 5 April 2020 (calendar week 14). The number of patients, total ischemic times and door-to-balloon times in temporal relation to COVID-19-related restrictions and infection rates were analyzed. While rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%)), total ischemic times increased from 164 (interquartile range (IQR): 107-281) min (calendar week 9/10) to 237 (IQR: 141-560) min (calendar week 11/12) and to 275 (IQR: 170-590) min (calendar week 13/14) (p = 0.006). Door-to-balloon times were constant (p = 0.60). There was a significant difference in post-interventional Thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients treated during calendar week 9/10 (97%), 11/12 (84%) and 13/14 (81%; p = 0.02). Rates of in-hospital death and re-infarction were similar between groups (p = 0.48). Results were comparable when dichotomizing data on 10 March and 16 March 2020, when official restrictions were executed. In this cohort of all-comer STEMI patients, we observed a 1.7-fold increase in ischemic time during the outbreak of COVID-19 in Austria. Patient-related factors likely explain most of this increase. Counteractive steps are needed to prevent further cardiac collateral damage during the ongoing COVID-19 pandemic.
Keyphrases
- st segment elevation myocardial infarction
- percutaneous coronary intervention
- coronavirus disease
- end stage renal disease
- newly diagnosed
- chronic kidney disease
- st elevation myocardial infarction
- ejection fraction
- coronary artery disease
- sars cov
- acute coronary syndrome
- prognostic factors
- peritoneal dialysis
- emergency department
- acute myocardial infarction
- heart failure
- antiplatelet therapy
- randomized controlled trial
- patient reported outcomes
- type diabetes
- oxidative stress
- coronary artery bypass grafting
- machine learning
- pulmonary embolism
- adipose tissue
- patient reported
- left ventricular
- brain injury
- skeletal muscle
- ischemia reperfusion injury
- placebo controlled
- pregnant women
- atrial fibrillation
- clinical trial
- insulin resistance
- case report
- acute ischemic stroke
- drug induced
- breast cancer risk