Key result
The COVID-19 pandemic was associated with a reduction in STEMI diagnoses during the first wave compared to 2019 (OR 0.76; 95% CI 0.60-0.93; p=0.011) and increased EMS mission times.
Why the study?
Little evidence existed regarding the impact of the COVID-19 pandemic on the STEMI time-dependent network during the post-pandemic phase, information critical for pre-hospital clinical protocols.
Does the COVID-19 pandemic alter STEMI diagnoses and emergency medical system mission times in a regional network?
Cohort
Yes
Does the COVID-19 pandemic alter STEMI diagnoses and emergency medical system mission times in a regional network?
Odds Ratio: 0.76 (95% CI 0.6–0.93)
p-value: p=0.011
The COVID-19 pandemic significantly increased EMS transportation times and reduced STEMI diagnoses and available HUBs in Lombardy, though pre-hospital clinical protocols like fibrinolysis did not require alteration.
Post-pandemic STEMI transport times recovered to baseline in Lombardy; leaves open whether EMS networks elsewhere show similar resilience.
Objectives: The COVID-19 pandemic had a significant impact on emergency medical systems (EMS). Regarding the ST-elevation myocardial infarction (STEMI) dependent time network, however, there is little evidence linked to the post-pandemic phase regarding this issue. Such information could prove to be of pivotal importance regarding STEMI clinical management, especially pre-hospital clinical protocols such as fibrinolysis. Methods: A retrospective observational cohort study of all STEMI rescues recorded in the Lombardy EMS registry from the 1st of January 2019 to the 30th of December 2021. Results: Regarding the number of STEMI diagnoses, March 2020 (first pandemic wave in Italy) saw a reduction compared to March 2019 (OR 0.76 [0.60–0.93], p = 0.011). The average time of the entire mission increased to 63.1 min in 2021, reaching 64.7 min in 2020, compared with 57.7 min in 2019. The number of HUBs for STEMI patients saw a reduction, falling from 52 HUBs in the pre-pandemic phase to 13 HUBs during the first wave. Conclusions: During the pandemic phase, there was an increase in the transportation times of STEMI patients from home to the hospital. Such changes did not alter the clinical approach in the out-of-hospital phase. Indeed, the implementation of fibrinolysis was not required.
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Stirparò et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI). COVID-19 pandemic vs. Pre-pandemic phase (2019) was evaluated on Number of STEMI diagnoses (OR 0.76, 95% CI 0.60-0.93, p=0.011). The COVID-19 pandemic was associated with a reduction in STEMI diagnoses during the first wave compared to 2019 (OR 0.76; 95% CI 0.60-0.93; p=0.011) and increased EMS mission times.
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