Abstract
BackgroundThe current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate.MethodsClinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019.ResultsA total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797).ConclusionsDuring the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations.Supplementary InformationThe online version of this article (10.1007/s12471-021-01653-9) contains supplementary material, which is available to authorized users.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic poses a major burden on health care systems worldwide and might negatively affect standard care for patients in need of urgent interventions
During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for segment elevation myocardial infarction (STEMI), with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations
A significant increase in total treatment delay of 19 min was observed during the COVID-19 outbreak, with patient delay being the most important driving factor
Summary
The coronavirus disease 2019 (COVID-19) pandemic poses a major burden on health care systems worldwide and might negatively affect standard care for patients in need of urgent interventions. In the case of ST-segment elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) reduces mortality when performed within guidelinerecommended time frames, the effect of the reduction of door-to-balloon time (DTB) to below 90 min and time from onset to door remains debatable [1,2,3,4,5,6]. The objective was to quantify changes in treatment delay and related outcomes, comparing the pre-COVID-19 phase, the peak phase of COVID-19 in the Netherlands and the recovery phase in 2020 to the equivalent periods in 2019 and comparing high-endemic and low-endemic Dutch regions. The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate
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