Key result
During the COVID-19 outbreak response, fewer STEMI patients presenting directly achieved a door-to-balloon time of <90 minutes compared to before the outbreak (71.4% vs. 80.9%), though in-hospital mortality remained similar.
Why the study?
Little was known about the effect of the COVID-19 pandemic and outbreak response measures on door-to-balloon time and clinical outcomes in STEMI patients undergoing primary PCI.
Does admission during the COVID-19 outbreak response delay door-to-balloon time and worsen clinical outcomes in STEMI patients undergoing primary PCI?
Observational (n=303)
Yes
Does admission during the COVID-19 outbreak response delay door-to-balloon time and worsen clinical outcomes in STEMI patients undergoing primary PCI?
The COVID-19 pandemic and outbreak response measures significantly reduced the proportion of STEMI patients achieving guideline-directed door-to-balloon times, which was associated with an increased risk of mortality.
Longer D2B times during COVID-19 may signal care disruptions; leaves open whether targeted protocols improve STEMI outcomes.
BACKGROUND: Little is known about the effect of the coronavirus disease 2019 (COVID-19) pandemic and the outbreak response measures on door-to-balloon time (D2B). This study examined both D2B and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: This was a retrospective study of 303 STEMI patients who presented directly or were transferred to a tertiary hospital in Singapore for PPCI from October 2019 to March 2020. We compared the clinical outcomes of patients admitted before (BOR) and during (DOR) the COVID-19 outbreak response. The study outcomes were in-hospital death, D2B, cardiogenic shock and 30-day readmission. For direct presentations, fewer patients in the DOR group achieved D2B time <90 min compared with the BOR group (71.4% vs. 80.9%, P=0.042). This was more apparent after exclusion of non-system delay cases (DOR 81.6% vs. BOR 95.9%, P=0.006). Prevalence of both out-of-hospital cardiac arrest (9.5% vs. 1.9%, P=0.003) and acute mitral regurgitation (31.6% vs. 17.5%, P=0.006) was higher in the DOR group. Mortality was similar between groups. Multivariable regression showed that longer D2B time was an independent predictor of death (odds ratio 1.005, 95% confidence interval 1.000-1.011, P=0.029). CONCLUSIONS: The COVID-19 pandemic and the outbreak response have had an adverse effect on PPCI service efficiency. The study reinforces the need to focus efforts on shortening D2B time, while maintaining infection control measures.
No takes yet. Share an insight, caveat, or question.
Chew et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=303). COVID-19 outbreak response vs. Before outbreak response was evaluated on Door-to-balloon time <90 min (direct presentations) (p=0.042). During the COVID-19 outbreak response, fewer STEMI patients presenting directly achieved a door-to-balloon time of <90 minutes compared to before the outbreak (71.4% vs. 80.9%), though in-hospital mortality remained similar.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: