Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

William Kamarullah; Marthin Alexander Rocky; Darius Revin Gozali

doi:10.1016/j.ihj.2021.06.009

June 25, 2021Indian Heart JournalOpen Access

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

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Why the study?

There was concern regarding whether the decrease in STEMI cases during the COVID-19 pandemic was related to unsatisfactory performance of STEMI systems of care and worsening clinical outcomes.

Does the COVID-19 pandemic affect systems of care and clinical outcomes in STEMI patients?

Structured PICO

Does the COVID-19 pandemic affect systems of care and clinical outcomes in STEMI patients?

P

Population

62,247 STEMI patients from 35 observational studies

I

Intervention

STEMI admission during the COVID-19 outbreak (n=10,263)

C

Comparator

STEMI admission before the COVID-19 outbreak (n=51,984)

O

Outcome

STEMI admission rates, primary PCI rates, symptom-to-FMC time, door-to-balloon (DTB) time, final TIMI 3 flow, and in-hospital mortalityhard clinical

The COVID-19 pandemic significantly disrupted STEMI systems of care, leading to delayed presentations and reduced primary PCI rates, though in-hospital mortality remained similar.

Implication

STEMI care metrics deteriorated early in the pandemic with partial late recovery; confirms system vulnerabilities and leaves open needs for resilient protocols in crises.

Abstract

INTRODUCTION: There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter. METHODS: We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak. RESULTS: Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak (n = 10,263) in contrast to before the outbreak period (n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups. CONCLUSION: There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.