The COVID-19 pandemic period was associated with a 13-minute reduction in median door-to-device time for STEMI patients undergoing primary percutaneous coronary intervention compared to the previous year, with no significant difference in 15-day major adverse cardiac events.
Observational (n=139)
No
Does STEMI management with PPCI during the COVID-19 outbreak worsen time intervals to reperfusion or 15-day MACE compared to pre-outbreak management?
STEMI management with primary PCI during the COVID-19 outbreak, utilizing infection control protocols, did not delay reperfusion times or worsen 15-day clinical outcomes compared to pre-pandemic care.
Absolute Event Rate: 47% vs 60%
p-value: p=0.007
Abstract Background ST-Elevation Myocardial Infarction (STEMI) is associated with high mortality and morbidity. In order to minimize cardiac tissue injury, primary per-cutaneous coronary intervention (PPCI) as treatment of choice should be performed as soon as possible. Coronavirus Disease 2019 (COVID-19) as an ongoing major global concern affects the other parts of health care system. Applying preventive strategies during this outbreak is necessary. However, critical times in STEMI management and outcomes may be influenced by infection control protocols implementation. The aim of this study is to investigate the differences in time intervals related to STEMI care and 15-day major adverse cardiac events (MACE) during this outbreak compared with the same period in last year and to determine whether the STEMI protocol should be changed to thrombolytic therapy during COVID-19 outbreak or not. Methods The patients with STEMI who underwent PPCI in Tehran Heart Center were included. Chest Computed tomography (CT) imaging and real time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) were only performed for COVID-19 suspected patients. Seventy-seven patients from 29 th February to 29 th March 2020 were compared with 62 patients from 1 st to 30 th March 2019. Results COVID-19 infection was confirmed by rRT-PCR in 5 cases. CT imaging in 4 out of 5 patients was in favor of COVID-19. The median of door-to-device time was reduced 13 minutes during this outbreak (p: 0.007). In-hospital mortality before and during outbreak was 3.22% and 5.19%, respectively (p: 0.57). Confirmed infection with COVID-19 was only reported in one of expired cases. The difference in 15-day MACE between two time periods was not statistically significant. Discussion/Conclusion Given that 15-day outcome in acute STEMI patients is not affected by COVID-19 outbreak, we did not find it reasonable to change our protocol. However, further studies are needed to determine a standard protocol for emergency management.
Salarifar et al. (Wed,) conducted a observational in ST-segment Elevation Myocardial Infarction (STEMI) (n=139). COVID-19 pandemic period vs. Same period in 2019 (historical cohort) was evaluated on Median door-to-device time (minutes) (p=0.007). The COVID-19 pandemic period was associated with a 13-minute reduction in median door-to-device time for STEMI patients undergoing primary percutaneous coronary intervention compared to the previous year, with no significant difference in 15-day major adverse cardiac events.
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