Abstract
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.
Highlights
The COVID-19 pandemic negatively affected access to healthcare system and timeline of treatment [1,2,3,4]
Both COVID-19 positive and negative patients were well matched and there were no disparities in baseline characteristics
Similar extent of coronary artery disease in angiography as well as TIMI flow grades before and after percutaneous coronary intervention (PCI) were reported during off-hours
Summary
The COVID-19 pandemic negatively affected access to healthcare system and timeline of treatment [1,2,3,4]. Some data suggest additional treatment delay for PCIs performed during off-hours [13,14]. Patients with STEMI are associated with more extensive use of potent antithrombotic and antiplatelet treatment. These agents might be linked with a higher rate of bleeding and vascular complications [5,6]. We sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with STEMI treated during regular and nonregular hours of work
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