Key result
COVID-19 pandemic linked to ~35-minute increase in STEMI primary angioplasty system delay.
Why the study?
The COVID-19 pandemic negatively impacted STEMI care indicators with a potential increase in morbidity and mortality, prompting evaluation of care delays and mortality at a public hospital in Brazil.
Does the COVID-19 pandemic increase time delays in STEMI care for patients undergoing primary angioplasty?
Observational (n=336)
No
Does the COVID-19 pandemic increase time delays in STEMI care for patients undergoing primary angioplasty?
Mean Difference: 35
Absolute Event Rate: 178% vs 145%
p-value: p=0.037
The COVID-19 pandemic significantly increased system delays for STEMI care at a Brazilian public hospital, though it did not significantly impact total delay or in-hospital mortality.
Pandemic system delays in STEMI merit ongoing surveillance; Level 3 data leaves open generalizability and mitigation strategies.
Background: International publications have shown that the COVID-19 pandemic has negatively impacted the indicators of care for ST-segment elevation acute myocardial infarction (STEMI), with a potential increase in morbidity and mortality. Objectives: To compare mortality, time from symptom onset to primary angioplasty (total delay [TD]), time from symptom onset to initial medical contact (patient delay [PD]), and time from initial medical contact to guidewire insertion in the hemodynamics laboratory (system delay [SD]) among patients admitted for STEMI at the Hemodynamics Service of Santa Casa de Passos, Minas Gerais, Brazil before and after the declaration of the COVID-19 pandemic by the World Health Organization, assessing the impact of the COVID-19 pandemic on STEMI care indicators. Methods: This is a before-and-after study involving patients hospitalized with STEMI undergoing primary angioplasty. Data were collected retrospectively through medical record review. Clinical and demographic profiles and outcomes between the pre-pandemic and pandemic groups were compared using the chi-square test for categorical variables or Student's t-test for continuous variables. A significance level of p < 0.05 was adopted. Results: There were no differences in TD (pre-pandemic: 300 min [± 159 min], 95% CI 277.1 to 322.6; pandemic: 300 min [± 148 min], 95% CI 274.3 to 326.6, p = 0.97). However, there was an increase in SD (pre-pandemic: 145 min [± 97 min], 95% CI 122.7 to 167.9; pandemic: 178 min [± 96 min], 95% CI 157.4 to 197.9, p = 0.037). There was no increase in PD (pre-pandemic: 145 min ± 133 min; pandemic: 130 min ± 117 min, p = 0.44), and no differences in mortality were observed (pre-pandemic: 9.7%; pandemic: 12%, p = 0.49). Conclusion: The COVID-19 pandemic increased SD in the management of STEMI in the region of Passos, Minas Gerais. There were no differences in PD, TD, and in-hospital mortality.
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Vargas et al. (2023) conducted an observational in ST-segment elevation acute myocardial infarction (STEMI) (n=336). COVID-19 pandemic vs. Pre-pandemic period was evaluated on System delay (time from initial medical contact to guidewire insertion) (MD 35, p=0.037). The COVID-19 pandemic significantly increased the system delay for STEMI patients undergoing primary angioplasty by an average of 35 minutes, with no significant differences in total delay or in-hospital mortality.
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