Abstract
ST-segment elevation myocardial infarction (STEMI) is a common cardiovascular emergency for which timely reperfusion therapies are needed to minimize myocardial necrosis. The aim of this study was to investigate the impact of the COVID-19 pandemic and reorganization of chest pain centers (CPC) on the practice of primary percutaneous coronary intervention (PPCI) and prognosis of STEMI patients. This single-center retrospective survey included all patients with STEMI admitted to our CPC from January 22, 2020 to April 30, 2020 (during COVID-19 pandemic in Wuhan), compared with those admitted during the analogous period in 2019, in respect of important time points of PPCI and clinical outcomes of STEMI patients. In the present article, we observed a descending trend in STEMI hospitalization and a longer time from symptom onset to first medical contact during the COVID-19 pandemic as compared to the control period (4.35 h versus 2.58 h). With a median delay of 17 minutes in the door to balloon time (D2B), the proportion of in-hospital cardiogenic shock was significantly higher in the COVID-19 era group (47.6% versus 19.5%), and major adverse cardiac events (MACE) tend to increase in the 6-month follow-up period (14.3% versus 2.4%). Although the reorganization of CPC may prolong the D2B time, immediate revascularization of the infarct-related artery could be offered to most patients within 90 minutes upon arrival. PPCI remained the preferred treatment for patients with STEMI during COVID-19 pandemic in the context of timely implementation and appropriate protective measures.
Highlights
Since the late December 2019, COVID-19 caused by a novel severe acute respiratory syndrome coronavirus (SARSCOV-2) has rapidly swept the world in a few months [1, 2]
2.1 Study design and participants. This single-center retrospective survey included all patients with segment elevation myocardial infarction (STEMI) admitted to our medical center from January 22, 2020 to April 30, 2020, and patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) in our hub during the corresponding time period of previous year (January 22 to April 30, 2020) were enrolled as a control group. Patients included in this analysis met the following criteria: ⃝1 patients who were clinical diagnosed as acute myocardial infarction with persistent ST-segment arch-like elevation in at least two contiguous electrocardiogram (ECG) leads or new bundle branch blocks, together with rise of cardiac troponin values with at least one above the 99th percentile of the upper reference limit [12]; ⃝2 all those STEMI patients with complete clinical records and followup data who received PPCI in our medical center
The D2B time in the COVID-19 era group were significantly extended by 17 min compared with control group, and the SO-to-FMC time extended by 1.77 h, which was longer than the data (0.89 h) from China Chest Pain Center (CCPC) reported by Xiang et al [10]
Summary
Since the late December 2019, COVID-19 caused by a novel severe acute respiratory syndrome coronavirus (SARSCOV-2) has rapidly swept the world in a few months [1, 2]. The COVID-19 outbreak has caused unprecedent healthcare and socioeconomic crisis worldwide, and greatly impacted the clinical practice of other diseases. Multiple investigators have reported a reduction of patients admitted for acute coronary syndrome (ACS) during the early days of COVID-19 pandemic [9]. Xiang et al revealed delayed time to primary reperfusion and higher rates of in-hospital mortality and heart failure for patients with STEMI admitted during COVID-19 outbreak, which indicated the importance of timely and effective reperfusion therapy. Few studies have focused on the reperfusion timeliness and shortterm outcomes of patients receiving PPCI during the pandemic
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