Increase of Myocardial Ischemia Time and Short-Term Prognosis of Patients with Acute Myocardial Infarction during the First COVID-19 Pandemic Wave.

Povilas Budrys,Romualdas Buivydas,Aleksandr Volodko,Pranas Serpytis,Vilhelmas Bajoras,Aurelija Martinonyte,Mindaugas Lizaitis,Greta Rodevic,Egle Urbonaite,Jelena Celutkiene,Ignas Badaras,Rasa Visinskiene,Romualdas Gurevicius,Laurynas Dieckus,Kamile Cerlinskaite-Bajore,Giedrius Davidavicius

doi:10.3390/medicina57121296

Povilas Budrys, Romualdas Buivydas + Show 14 more

Open Access

https://doi.org/10.3390/medicina57121296

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Abstract

Background and objectives: early reports showed a decrease in admission rates and an increase in mortality of patients with acute myocardial infarction (AMI) during the first wave of COVID-19 pandemic. We sought to investigate whether the COVID-19 pandemic and associated lockdown had an impact on the ischemia time and prognosis of patients suffering from AMI in the settings of low COVID-19 burden. Materials and Methods: we conducted a retrospective data analysis from a tertiary center in Lithuania of 818 patients with AMI. Data were collected from 1 March to 30 June in 2020 during the peri-lockdown period (2020 group; n = 278) and compared to the same period last year (2019 group; n = 326). The primary study endpoint was all-cause mortality during 3 months of follow-up. Secondary endpoints were heart failure severity (Killip class) on admission and ischemia time in patients with acute ST segment elevation myocardial infarction (STEMI). Results: there was a reduction of 14.7% in admission rate for acute myocardial infarction (AMI) during the peri-lockdown period. The 3-month mortality rate did not differ significantly (6.9% in 2020 vs. 10.5% in 2019, p = 0.341 for STEMI patients; 5.3% in 2020 vs. 2.6% in 2019, p = 0.374 for patients with acute myocardial infarction without ST segment elevation (NSTEMI)). More STEMI patients presented with Killip IV class in 2019 (13.5% vs. 5.5%, p = 0.043, respectively). There was an increase of door-to-PCI time (54.0 [42.0–86.0] in 2019; 63.5 [48.3–97.5] in 2020, p = 0.018) and first medical contact (FMC)-to-PCI time (101.0 [82.5–120.8] in 2019; 115 [97.0–154.5] in 2020, p = 0.01) during the pandemic period. Conclusions: There was a 14.7% reduction of admissions for AMI during the first wave of COVID-19. FMC-to-PCI time increased during the peri-lockdown period, however, it did not translate into worse survival during follow-up.

Highlights

The COVID-19 pandemic was associated with more than 4,000,000 deaths worldwide [1]
We sought to investigate whether the COVID-19 pandemic and the first wave-related lockdown had an impact on the myocardial ischemia time, severity of presentation, and short-term prognosis of patients suffering from acute myocardial infarction in the tertiary
All patients from Vilnius and surrounding regions with acute myocardial infarction are referred for percutaneous coronary intervention (PCI) to this center

Summary

Introduction

The COVID-19 pandemic was associated with more than 4,000,000 deaths worldwide [1]. In Lithuania, the lockdown due to the first wave of COVID-19 was implemented on 16 March 2020 and lasted for three months. To prevent the spread of infection in the hospital among medical staff and patients some precautionary measures were implemented like routine testing of patients for SARSCoV-2 virus at the emergency ward, change in the treatment algorithms with emphasis to limit patient transfers between the hospitals, and usage of personal protective equipment (PPE) by medical workers. These changes caused delays in timely diagnosis and treatment of various diseases, and possibly affected patient prognosis. Little information was given on the awareness and readiness of hospitals to provide necessary cardiac care services

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