[Impact of COVID-19 on ST-segment Elevation Myocardial Infarction Care. The Spanish Experience]

Introduction And Objectives: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.

Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.

Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.

Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Citing Articles

[Impact of the COVID-19 pandemic on ST - elevation myocardial infarction management in a reference center of northern Peru].

Carrion Arcela J, Custodio-Sanchez P, Coca Caycho T Arch Peru Cardiol Cir Cardiovasc. 2023; 2(3):159-166.

PMID: 37727520 PMC: 10506557. DOI: 10.47487/apcyccv.v2i3.148.

Impact of the COVID-19 pandemic on visits to the hospital emergency service in two hospitals in Spain, from March 14, 2020 to June 21, 2020.

Gonzalez I, Alonso Valle H, Abejez L, Molas A, Alonso-Molero J, Dierssen-Sotos T Intern Emerg Med. 2023; 18(7):2093-2103.

PMID: 37308693 PMC: 10259810. DOI: 10.1007/s11739-023-03328-2.

Impact of Coronavirus-19 Pandemic and Lockdown on Admissions for Ischemic Heart Disease.

Garcia J, Iturregui Guevara M, Garcia E, Campuzano Ruiz R, Garcia R Cardiol Cardiovasc Med. 2023; 6(4):353-363.

PMID: 36968309 PMC: 10035782. DOI: 10.26502/fccm.92920270.

Use of Cardiac Procedures in People with Diabetes during the COVID Pandemic in Spain: Effects on the In-Hospital Mortality.

Lopez-de-Andres A, Jimenez-Garcia R, Carabantes-Alarcon D, Hernandez-Barrera V, de-Miguel-Yanes J, de-Miguel-Diez J Int J Environ Res Public Health. 2023; 20(1).

PMID: 36613166 PMC: 9819421. DOI: 10.3390/ijerph20010844.

[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022].

Del Cura-Gonzalez I, Polentinos-Castro E, Fontan-Vela M, Lopez-Rodriguez J, Martin-Fernandez J Gac Sanit. 2022; 36 Suppl 1:S36-S43.

PMID: 35781146 PMC: 9244613. DOI: 10.1016/j.gaceta.2022.03.003.

References

Karam N, Bataille S, Marijon E, Tafflet M, Benamer H, Caussin C . Incidence, Mortality, and Outcome-Predictors of Sudden Cardiac Arrest Complicating Myocardial Infarction Prior to Hospital Admission. Circ Cardiovasc Interv. 2019; 12(1):e007081. DOI: 10.1161/CIRCINTERVENTIONS.118.007081. View

Lau J, Griffiths S, Choi K, Tsui H . Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong. BMC Infect Dis. 2010; 10:139. PMC: 2891756. DOI: 10.1186/1471-2334-10-139. View

Jing Z, Zhu H, Yan X, Chai W, Zhang S . Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak. Eur Heart J. 2020; 41(19):1791-1794. PMC: 7184505. DOI: 10.1093/eurheartj/ehaa258. View

Kannan V, Veazie P . Predictors of avoiding medical care and reasons for avoidance behavior. Med Care. 2014; 52(4):336-45. DOI: 10.1097/MLR.0000000000000100. View

De Luca G, Suryapranata H, Ottervanger J, Antman E . Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004; 109(10):1223-5. DOI: 10.1161/01.CIR.0000121424.76486.20. View

Moroni F, Gramegna M, Ajello S, Beneduce A, Baldetti L, Vilca L . Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic. JACC Case Rep. 2020; 2(10):1620-1624. PMC: 7252183. DOI: 10.1016/j.jaccas.2020.04.010. View

Welt F, Shah P, Aronow H, Bortnick A, Henry T, Sherwood M . Catheterization Laboratory Considerations During the Coronavirus (COVID-19) Pandemic: From the ACC's Interventional Council and SCAI. J Am Coll Cardiol. 2020; 75(18):2372-2375. PMC: 7270593. DOI: 10.1016/j.jacc.2020.03.021. View

Garcia S, Albaghdadi M, Meraj P, Schmidt C, Garberich R, Jaffer F . Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic. J Am Coll Cardiol. 2020; 75(22):2871-2872. PMC: 7151384. DOI: 10.1016/j.jacc.2020.04.011. View

Alvarez A, Rodriguez Leor O, Moreno R, de Prado A . Spanish Cardiac Catheterization and Coronary Intervention Registry. 28th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2018). Rev Esp Cardiol (Engl Ed). 2019; 72(12):1043-1053. DOI: 10.1016/j.rec.2019.10.005. View

10.

St John Sutton M, Lee D, Rouleau J, Goldman S, Plappert T, Braunwald E . Left ventricular remodeling and ventricular arrhythmias after myocardial infarction. Circulation. 2003; 107(20):2577-82. DOI: 10.1161/01.CIR.0000070420.51787.A8. View

11.

Brodie B, Webb J, Cox D, Qureshi M, Kalynych A, Turco M . Impact of time to treatment on myocardial reperfusion and infarct size with primary percutaneous coronary intervention for acute myocardial infarction (from the EMERALD Trial). Am J Cardiol. 2007; 99(12):1680-6. DOI: 10.1016/j.amjcard.2007.01.047. View

12.

De Filippo O, DAscenzo F, Angelini F, Bocchino P, Conrotto F, Saglietto A . Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med. 2020; 383(1):88-89. PMC: 7224608. DOI: 10.1056/NEJMc2009166. View

13.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

14.

Stefanini G, Montorfano M, Trabattoni D, Andreini D, Ferrante G, Ancona M . ST-Elevation Myocardial Infarction in Patients With COVID-19: Clinical and Angiographic Outcomes. Circulation. 2020; 141(25):2113-2116. PMC: 7302062. DOI: 10.1161/CIRCULATIONAHA.120.047525. View

15.

Romaguera R, Ribera A, Guell-Viaplana F, Tomas-Querol C, Munoz-Camacho J, Agudelo V . Decrease in ST-segment elevation myocardial infarction admissions in Catalonia during the COVID-19 pandemic. Rev Esp Cardiol (Engl Ed). 2020; 73(9):778-780. PMC: 7274622. DOI: 10.1016/j.rec.2020.06.001. View

16.

Bangalore S, Sharma A, Slotwiner A, Yatskar L, Harari R, Shah B . ST-Segment Elevation in Patients with Covid-19 - A Case Series. N Engl J Med. 2020; 382(25):2478-2480. PMC: 7182015. DOI: 10.1056/NEJMc2009020. View

17.

Baldi E, Sechi G, Mare C, Canevari F, Brancaglione A, Primi R . Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020; 383(5):496-498. PMC: 7204428. DOI: 10.1056/NEJMc2010418. View

18.

Dudas K, Lappas G, Stewart S, Rosengren A . Trends in out-of-hospital deaths due to coronary heart disease in Sweden (1991 to 2006). Circulation. 2010; 123(1):46-52. DOI: 10.1161/CIRCULATIONAHA.110.964999. View

19.

Rossello X, Lobo-Gonzalez M, Ibanez B . Editor's Choice- Pathophysiology and therapy of myocardial ischaemia/reperfusion syndrome. Eur Heart J Acute Cardiovasc Care. 2019; 8(5):443-456. DOI: 10.1177/2048872619845283. View