Key result
Presentation during the post-COVID-19 period was associated with a lower admission LVEF (45% vs. 50%, p=0.015) among patients with STEMI.
Why the study?
The COVID-19 pandemic reduced STEMI activations in epicenters, but its impact on presentation delay, severity, patterns of care, and reasons for delay in non-hot-spot regions was unclear.
Does the COVID-19 pandemic and associated stay-at-home orders affect presentation delay, severity, and patterns of care in patients with STEMI?
Cohort (n=143)
Yes
Does the COVID-19 pandemic and associated stay-at-home orders affect presentation delay, severity, and patterns of care in patients with STEMI?
Absolute Event Rate: 45% vs 50%
p-value: p=0.015
The COVID-19 pandemic and associated stay-at-home orders led to delayed STEMI presentations, resulting in lower admission LVEF and longer door-to-balloon times, largely driven by patient fear of the virus.
STEMI patients presented later with more severe infarcts after COVID onset; leaves open whether public messaging can reduce future delays in non-epicenters.
OBJECTIVES: We sought to study the impact of COVID-19 pandemic on the presentation delay, severity, patterns of care, and reasons for delay among patients with ST-elevation myocardial infarction (STEMI) in a non-hot-spot region. BACKGROUND: COVID-19 pandemic has significantly reduced the activations for STEMI in epicenters like Spain. METHODS: From January 1, 2020, to April 15, 2020, 143 STEMIs were identified across our integrated 18-hospital system. Pre- and post-COVID-19 cohorts were based on March 23rd, 2020, whenstay-at-home orders were initiated in Ohio. We used presenting heart rate, blood pressure, troponin, new Q-wave, and left ventricle ejection fraction (LVEF) to assess severity. Duration of intensive care unit stay, total length of stay, door-to-balloon (D2B) time, and radial versus femoral access were used to assess patterns of care. RESULTS: Post-COVID-19 presentation was associated with a lower admission LVEF (45 vs. 50%, p = .015), new Q-wave, and higher initial troponin; however, these did not reach statistical significance. Among post-COVID-19 patients, those with >12-hr delay in presentation 31(%) had a longer average D2B time (88 vs. 53 min, p = .033) and higher peak troponin (58 vs. 8.5 ng/ml, p = .03). Of these, 27% avoided the hospital due to fear of COVID-19, 18% believed symptoms were COVID-19 related, and 9% did not want to burden the hospital during the pandemic. CONCLUSIONS: COVID-19 has remarkably affected STEMI presentation and care. Patients' fear and confusion about symptoms are integral parts of this emerging public health crisis.
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Hammad et al. (2020) conducted a cohort in ST-elevation myocardial infarction (n=143). Post-COVID-19 period vs. Pre-COVID-19 period was evaluated on Admission left ventricle ejection fraction (LVEF) (p=0.015). Presentation during the post-COVID-19 period was associated with a lower admission LVEF (45% vs. 50%, p=0.015) among patients with STEMI.
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