Abstract
Background: The influence of the early COVID-19 pandemic on non-COVID-19 emergencies is uncertain. We conducted a systematic review and a meta-analysis to evaluate the impact of the first months of the COVID-19 pandemic on the presentation, management, and prognosis of patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We searched the PubMed, Scopus, and Embase databases from January to August 2020. A meta-analysis of studies comparing the profile, STEMI severity at presentation, reperfusion delay, and in-hospital mortality for patients presenting before and during the early COVID-19 pandemic was conducted. Fifteen cross-sectional observational studies including 20,528 STEMI patients from the pre-COVID period and 2190 patients diagnosed and treated during the first months of the COVID-19 pandemic met the inclusion criteria. Results: Patients presenting with STEMI during the pandemic were younger and had a higher comorbidity burden. The time interval between symptoms and first medical contact increased from 93.22 ± 137.37 min to 142 ± 281.60 min (p < 0.001). Door-to-balloon time did not differ significantly between the two periods (p = 0.293). The pooled odds ratio (OR) for low left ventricular ejection fraction at presentation during the pandemic was 2.24 (95% confidence interval (CI) 1.54–3.26) and for a presentation delay >24 h was 2.9 (95% CI 1.54–5.45) relative to before the pandemic. In-hospital mortality did not increase significantly during the outbreak (p = 0.97). Conclusion: During the first months of the COVID-19 pandemic, patients presenting with STEMI were addressed later in the course of the disease with more severe left ventricular impairment. In-hospital emergency circuits and care functioned properly with no increase in door-to-balloon time and early mortality.
Highlights
The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that was isolated in the Chinese city of Wuhan in December 2019 caught the entire world by surprise and rapidly evolved to a pandemic
Included studies met the following criteria: (1) the study focused on the impact of the first months of the COVID-19 pandemic on patients presenting with segment elevation myocardial infarction (STEMI) regarding reperfusion delay (symptom-to-first-medical-contact (FMC) time, door-to-balloon time, total ischemic time, presentation > 24 h), STEMI severity at presentation (LVEF, cTn-I), and in-hospital mortality; (2) the study was a cross-sectional observational study reporting data from a lockdown period or a period of maximal social/health care measures in the respective country; (3) the study provided the number of cases, means, and standard deviations or sufficient information to calculate them
A study was excluded from the meta-analysis if it (1) only provided information from the period associated to the early COVID-19 pandemic and no comparison with a pre-COVID-19 control group from the same institution(s); (2) presented only percentages, percentage differences, or mean values differences; (3) was a low-quality investigation
Summary
The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that was isolated in the Chinese city of Wuhan in December 2019 caught the entire world by surprise and rapidly evolved to a pandemic. Medical systems worldwide were forced to adopt measures to prevent the spread of the coronavirus disease (COVID-19). Authorities all around the world issued new laws and recommendations restricting certain rights and freedoms (movement, travel), limiting social interaction, and imposing self-confinement. (movement, travel), limiting social interaction, and imposing self-confinement. Medical systems were redesigned, with certain facilities being transformed into. COVID-19 hospitals, new triage systems, patient separation, limitation of presenta2toifo1n3s in an outpatient setting, and novel management of emergencies. COVmIDed-1ic9alssyymstpemtosmwser[e2]a,lsloacrkedoefsicgonrerde,cwt iitnhfcoerrmtaaintifoancilcitoienscbeerinnigntgratnhsefosrtmateedoinftmo CedOiVcIaDl -services1,9anhodslpoictaklds,onwenwmtreiaagseurseyss.tems, patient separation, limitation of presentations in an oNuotpna-tCieOntVsIeDtti-n1g9, eamndenrgoevnelcmieasnwageerme eanlstoofaefmfeecrtgeednbciyest.hPeatpieanntds ebmeciacm. OVID-19 pandemic on the presentation, management, The international prospective register of systematic reviews (PROSPERO) registration n2.uMmabteerrifaolsr atnhdisMsteutdhyodiss: CRD42020202468. The international prospective register of systematic reviews (PROSPERO) registration.
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