Abstract
Introduction: ST-elevation myocardial infarctions (STEMIs) are emergencies requiring rapid intervention. COVID-19 has been associated with a reduction in acute presentations to ER’s, however the effect on STEMI presentations (incidence, mortality, and severity) remains unclear. Methods: STEMI presentation data from 2012 to 2022 were obtained from our database. There were 647 STEMI activations pre-pandemic (81 per year) and 61 STEMI activations during the pandemic (30 per year). The STEMI activations were further characterized as false alerts or true STEMIs (undergoing emergent catheterization). Unpaired t-tests were conducted to analyze the difference between the groups. Results: The percentage of true STEMIs during COVID-19 was higher than pre-COVID-19 (85.9% vs 71.4%; p<0.01 ). Mean age pre-COVID-19 vs during COVID-19 was 60.4 years vs 58.4 years, while male sex was equal between both groups (72% vs 75%). Mean peak troponin levels of patients presenting during COVID-19 were lower than pre-COVID-19 (16.9 ng/L vs 51.5 ng/L; p< 0.03 ). The 30-day mortality rate was higher in the COVID-19 group than in the pre-COVID-19 (12.9% vs 9.8% p-value: NS) group. Use of mechanical support was higher during COVID-19, relative to pre-COVID-19 (21% vs 8.5%; p<0.001 ). One young patient presented as a delayed STEMI with a post-infarct VSD ultimately needing cardiac transplantation during the pandemic. Conclusion: During COVID-19, the overall STEMI activations decreased significantly. There was a higher incidence of true STEMIs, demonstrated by a lower rate of false alerts. This suggests that patients with more severe symptoms came to the hospital while patients with less severe/atypical symptoms may have avoided care. Lower peak troponin levels, yet more severe clinical outcomes (increased need for mechanical circulatory support, and a trend towards worse mortality), suggests delayed STEMI presentations during the pandemic. Further investigation is needed, given the ongoing dynamic nature of the pandemic.
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