Abstract
Objective: Since the outbreak of the COVID-19 pandemic, healthcare professionals reported declining numbers of patients admitted with ST-segment myocardial infarction (STEMI) associated with increased in-hospital morbidity and mortality. However, the effect of lockdown on outcomes of STEMI patients admitted during the COVID-19 crisis has not been prospectively evaluated.Methods: A prospective, observational study on STEMI patients admitted to our tertiary care center during the COVID-19 pandemic was conducted. Outcomes of patients admitted during lockdown were compared to those patients admitted before and after pandemic-related lockdown.Results: A total of 147 patients were enrolled in our study, including 57 patients in the pre-lockdown group (November 1, 2019 to March 20, 2020), 16 patients in the lockdown group (March 21 to April 19, 2020), and 74 patients in the post-lockdown group (April 20 to September 30, 2020). Patients admitted during lockdown had significantly longer time to first medical contact, longer door-to-needle-time, higher serum troponin T levels, worse left ventricular end-diastolic pressure, and higher need for circulatory support. After a median follow-up of 142 days, survival was significantly worse in STEMI patients of the lockdown group (log-rank: p = 0.0035).Conclusions: This is the first prospective study on outcomes of STEMI patients admitted during public lockdown amid the COVID-19 pandemic. Our results suggest that lockdown might deteriorate outcomes of STEMI patients. Public health strategies to constrain spread of COVID-19, such as lockdown, have to be accompanied by distinct public instructions to ensure timely medical care in acute diseases such as STEMI.
Highlights
Soon after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread globally, physicians warned about potential side effects of the COVID-19 pandemic compromising medical care [1, 2]
From March 21, 2020, when measures of social restrictions were implemented for the first time during the COVID-19 pandemic in Germany, until the end of our inclusion period on September 31, 2020, 90 patients with segment elevation myocardial infarction (STEMI) had been admitted to our tertiary care center
Characteristics of 57 STEMI patients admitted before the COVID-19 pandemic (“prelockdown group”) were assessed
Summary
Soon after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread globally, physicians warned about potential side effects of the COVID-19 pandemic compromising medical care [1, 2]. Patients with ST-segment elevation myocardial infarction (STEMI) are an especially vulnerable population, as total ischemic time severely influences their outcome [6]. There have been several reports on diminishing numbers of STEMI admissions during the outbreak in both epicenters and nonepicenters of the COVID-19 pandemic. This has been associated with significantly prolonged times from symptom onset to first medical contact (FMC) and increased in-hospital morbidity and mortality [7,8,9,10,11]. The influence of factors such as lockdown, stress, and fear of COVID-19 on the patient’s long-term outcome, has not yet been evaluated
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