Key result
The COVID-19 pandemic was associated with a significant decrease in primary percutaneous coronary intervention procedures for STEMI patients compared to the pre-pandemic period (27.8% vs. 65.2%, p<0.001).
Why the study?
The emergence of COVID-19 posed obstacles to prompt STEMI management and prompted policy changes emphasizing fibrinolytic therapy, but its effects in Indonesia remained to be identified.
How did the COVID-19 pandemic affect the management, reperfusion times, and clinical outcomes of STEMI patients in Indonesia?
Cohort
No
How did the COVID-19 pandemic affect the management, reperfusion times, and clinical outcomes of STEMI patients in Indonesia?
Absolute Event Rate: 27.8% vs 65.2%
p-value: p=<0.001
The COVID-19 pandemic significantly delayed presentation and shifted STEMI management away from primary PCI toward conservative and fibrinolytic therapy in Indonesia, though without a statistically significant impact on clinical outcomes.
Delays in STEMI presentation and PPCI occurred during COVID-19 without affecting mortality; leaves open whether fibrinolytic shifts warrant prospective evaluation.
<ns4:p> <ns4:bold>Background:</ns4:bold> ST-segment elevation myocardial infarction (STEMI) is a form of acute coronary syndrome with high mortality rate. Management of STEMI should be performed as soon as possible to prevent further damage. With the emergence of coronavirus disease 2019 (COVID-19), it may face obstacles. To overcome those problems, some changes in policy focusing on fibrinolytic therapy in STEMI patients have been applied. This study aimed to identify the effects of COVID-19 in management of STEMI patients in Indonesia. </ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> This retrospective study was conducted in Dr. Cipto Mangunkusumo Hospital (CMH), the national referral center in Indonesia. We compared data between 2018 to 2019 and 2020 to 2021 as before and during COVID-19 pandemic period, respectively. We analyzed the effects of COVID-19 on STEMI patients' visits to hospital <ns4:italic>i.e</ns4:italic> ., monthly hospital admission and symptoms-to-hospital, management of STEMI <ns4:italic>i.e</ns4:italic> ., the strategies and time of reperfusion, and clinical outcomes of STEMI patients <ns4:italic>i.e</ns4:italic> ., major adverse coronary event and mortality. </ns4:p> <ns4:p> <ns4:bold>Results:</ns4:bold> There was a significant statistically reduced mean of monthly hospital admissions from 11 to 7 (p = 0.002) and prolonged duration of symptoms-to-hospital during COVID-19 from 8 to 12 hours (p = 0.005). There was also a decrease in primary percutaneous coronary intervention (PPCI) procedures during COVID-19 (65.2% vs. 27.8%, p<0.001), which was accompanied by an increased number of fibrinolytic (1.5% vs. 9.5%, p<0.001) and conservative therapy (28.5% vs. 55.6%, p <0.01). Moreover, there was also a prolonged duration of diagnosis-to-wire-crossing time (160 vs. 186 minutes, p = 0.005), meanwhile, percentage of urgent PCI, door-to-needle time, and clinical outcomes were not statistically significant. </ns4:p> <ns4:p> <ns4:bold>Conclusions:</ns4:bold> During COVID-19 pandemic, the number STEMI patients declined in monthly hospital admission, delays in symptoms-to-hospital time, changes in type of reperfusion strategy, and delays in PPCI procedures in CMH. Meanwhile, fibrinolytic time and clinical outcomes were not affected. </ns4:p>
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Ginanjar et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI). COVID-19 pandemic vs. Pre-COVID-19 period (2018-2019) was evaluated on Primary percutaneous coronary intervention (PPCI) procedures (p=<0.001). The COVID-19 pandemic was associated with a significant decrease in primary percutaneous coronary intervention procedures for STEMI patients compared to the pre-pandemic period (27.8% vs. 65.2%, p<0.001).
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