Consequences of COVID-19 Pandemic on Myocardial Infarction Reperfusion Therapy and Prognosis in a High-Volume PCI Center in Chile

Abstract

Background: Characterize the clinical profile, treatment, and evolution of patients with acute myocardial infarction (AMI) during the coronavirus disease 2019 (COVID-19) pandemic and compare them to a historical cohort. Methods: This was a case-control study comprising of AMI patients who were transferred to a high-volume percutaneous coronary intervention (PCI) hospital between March 3 and July 15, 2020 (n=96), and a historical cohort of patients who were transferred during the same weeks in 2019 (n=269). Results: Differing results during pandemic vs pre-pandemic included age (63±12 vs 68±12 years, p 12 hours from onset of symptoms (44.4% vs 0%, p<0.01), median door-to-device time (4 vs 3 hours, p<0.01), primary PCI (97% vs 71%, p<0.01), cardiogenic shock (19.8% vs 4.1%, p<0.01), mechanical complication (10.4% vs 1.7%, p<0.01), follow-up mortality at 30-days (19.8% vs 1.4% p<0.01) and cardiovascular deaths (12.5% vs 1.4%, p<0.01). During the outbreak, 40% of patients had positive COVID-19 status, which was a predictor for 30-day overall mortality (RR 2.90;95% CI 1.14-7.36). Conclusions: We observed a 67.4% reduction in AMI patient referrals during the pandemic. AMI patients exhibited delays in consults and treatment, higher morbidity and increased mortality. COVID-19 positivity was associated with a worse 30-day overall survival.