Key result
The COVID-19 pandemic lockdown was associated with a reduction in critical STEMI cases arriving at the acute cardiac care unit, including fewer KILLIP class III patients (7.3% vs 17.0%, P=0.04).
Why the study?
The study was conducted to investigate the impact of the COVID-19 pandemic on a regional network for the management of STEMI.
Did the COVID-19 pandemic lockdown impact the functionality and admission rates of a regional STEMI network?
Observational
No
Did the COVID-19 pandemic lockdown impact the functionality and admission rates of a regional STEMI network?
Absolute Event Rate: 7.3% vs 17%
p-value: p=0.04
The COVID-19 lockdown significantly reduced AMI admissions and the transfer of critical STEMI cases to a regional hub, despite maintaining cathlab functionality.
Observational single-center data suggest fewer AMI admissions during lockdown; leaves open network adaptations for future crises.
The COVID-19 pandemic has had a major impact on cardiovascular emergencies. The aim of this study was to investigate the impact of the COVID-19 pandemic on a regional network for management of ST-segment elevation acute myocardial infarction (STEMI). Methods: We report a single center’s experience of patients hospitalized for ACS in a high-volume hub of a STEMI network during the lockdown (in the first pandemic trimester), compared with the same time interval of the previous year and including all consecutive patients referred for an AMI during the second trimester of 2020 (from April to June) or during the same time interval of the previous year, 2019. Results: The absolute number of hospital admissions for AMI decreased by 22.3%, while the non-AMI hospitalizations decreased by 77.14% in Q2-2020 compared to Q2-2019 (210 vs. 48, p < 0.0001). As a consequence, the percentage of AMI cases from the total number of hospital admission increased from 38% to 68% (p < 0.0001), AMI becoming the dominant pathology. In the STEMI group there was a significant reduction of 55% in the absolute number of late STEMI presentations. Functionality of the STEMI network at the hub level did not present a significant alteration with only a minor increase in the door-to-balloon time, from 34 min to 41 min. However, at the level of the network we recorded a lower number of critical cases transferred to the interventional center, with a dramatic reduction of 56.1% in the number of critical STEMI cases arriving in the acute cardiac care unit (17.0% vs. 7.3%, p-0.04 for KILLIP class III, and 21.17% vs. 11.11%, p = 0.08 for resuscitated out of hospital cardiac arrest). Conclusions: The COVID-19 outbreak did not have a major impact on the interventional center’s functionality, but it limited the capacity of the regional STEMI network to bring the critical patient with complicated STEMI to the cathlab in time during the first months of the lockdown. Even a very well-functioning STEMI network like the one in Central Romania had difficulties bringing the most critical STEMI cases to the cathlab in time.
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Hodaş et al. (2021) conducted an observational in ST-segment elevation acute myocardial infarction (STEMI). COVID-19 pandemic lockdown (Q2-2020) vs. Same time interval of the previous year (Q2-2019) was evaluated on Proportion of STEMI cases presenting with KILLIP class III (p=0.04). The COVID-19 pandemic lockdown was associated with a reduction in critical STEMI cases arriving at the acute cardiac care unit, including fewer KILLIP class III patients (7.3% vs 17.0%, P=0.04).
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