The impact of COVID-19 pandemic on the treatment of patients with ST-segment elevation myocardial infarction: a single center experience

Abstract

Funding AcknowledgementsType of funding sources: None.BackgroundCOVID-19 pandemic created big pressure in healthcare systems and had significant impact with longer delays to treatment for patients with ST elevation acute myocardial infarction (STEMI).PurposeTo evaluate the impact of COVID-19 pandemic on the treatment delays in STEMI patients treated by primary percutaneous coronary intervention (PPCI) in a general hospital in Cyprus.MethodsProspective analysis of all consecutive patients that activated the PPCI service from 01.11.2020 to 30.09.2021, during the second wave of the pandemic in Cyprus. Main outcomes are the following quality indicators: the percentage of patients who received treatment within 12 hours (Total Ischaemic Time - TIT), the mean reperfusion time (time from STEMI diagnosis to wire crossing) based to the initial healthcare facility presentation (pPCI centre and non pPCI centre) and 30-days mortality.ResultsAmong the 270 activations of the primary angioplasty service during the above period, 228 were STEMI cases. Of these, 207 patients were treated with pPCI, 4 cases referred for emergency CABG, 10 cases treated conservatively (of them 6 cases of Takotsubo cardiomyopathy, 2 SCAD cases and 2 MINOCA cases) and 7 were false positive activations. For the patients treated with pPCI, the mean TIT was 5.8 hours and the overall percentage of patients who received treatment within 12 hours was 90%. The mean reperfusion time (mean time from STEMI diagnosis to wire crossing) was 110 minutes, while the median reperfusion time was 97 minutes. Patients presented directly to our PPCI centre (n = 94, 43%) had a mean reperfusion time of 80 minutes. Those admitted from other peripheral non-PPCI hospitals (n= 130, 57%), had a mean reperfusion time of 134 minutes (80 vs 134 minutes, p-value ≤ 0.001). In particular, patients presented in the reference hospital for COVID-19 in [name of country], showed the longest reperfusion times (DTB = 154 minutes, p-value ≤ 0.001). Cumulative 30-day mortality was 8.8%. The rate of 30-day mortality increased with longer reperfusion time (0.4 vs 1.8 vs 2.7 vs 3.2, p-value= 0.132).ConclusionsThe COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a longer delay to treatment, especially among patients who were transferred from the reference hospital for COVID-19 in Cyprus, which may have contributed to increased mortality during the pandemic.