Key result
The COVID-19 pandemic was significantly associated with a higher risk of delayed primary percutaneous coronary intervention (OR 7.040) in STEMI patients, driven by cumulative prolongations in multiple reperfusion procedures.
Why the study?
The COVID-19 pandemic burdened emergency care and challenged STEMI treatment, but its impact on mechanical reperfusion in a non-epicenter region was unclear.
Does the COVID-19 pandemic delay mechanical reperfusion times in STEMI patients undergoing PPCI in a non-epicenter region?
Observational (n=320)
Yes
Does the COVID-19 pandemic delay mechanical reperfusion times in STEMI patients undergoing PPCI in a non-epicenter region?
Odds Ratio: 7.04 (95% CI 3.61–13.729)
Absolute Event Rate: 34% vs 6.8%
p-value: p=<0.001
The COVID-19 pandemic significantly delayed mechanical reperfusion times for STEMI patients even in non-epicenter regions, highlighting the need to optimize emergency care pathways during public health crises.
May warrant resilient STEMI pathways in future crises; extends observational data to non-epicenter regions.
Objective: The COVID-19 pandemic placed heavy burdens on emergency care and posed severe challenges to ST-segment-elevation myocardial infarction (STEMI) treatment. This study aimed to investigate the impact of COVID-19 pandemic on mechanical reperfusion characteristics in STEMI undergoing primary percutaneous coronary intervention (PPCI) in a non-epicenter region. Methods: STEMI cases undergoing PPCI from January 23 to March 29 between 2019 and 2020 were retrospectively compared. PPCI parameters mainly included total ischemic time (TIT), the period from symptom onset to first medical contact (S-to-FMC), the period from FMC to wire (FMC-to-W) and the period from door to wire (D-to-W). Furthermore, the association of COVID-19 pandemic with delayed PPCI risk was further analyzed. Results: A total of 14 PPCI centers were included, with 100 and 220 STEMI cases undergoing PPCI in 2020 and 2019, respectively. As compared to 2019, significant prolongations occurred in reperfusion procedures (P < 0.001) including TIT (420 vs. 264 min), S-to-FMC (5 vs. 3 h), FMC-to-W (113 vs. 95 min) and D-to-W (83 vs. 65 min). Consistently, delayed reperfusion surged including TIT ≥ 12 h (22.0 vs.3.6%), FMC-to-W ≥ 120 min (34.0 vs. 6.8%) and D-to-W ≥ 90 min (19.0 vs. 4.1%). During the pandemic, the patients with FMC-to-W ≥ 120 min had longer durations in FMC to ECG completed (6 vs. 5 min, P = 0.007), FMC to DAPT (24 vs. 21 min, P = 0.001), catheter arrival to wire (54 vs. 43 min, P < 0.001) and D-to-W (91 vs. 78 min, P < 0.001). The pandemic was significantly associated with high risk of delayed PPCI (OR = 7.040, 95% CI 3.610–13.729, P < 0.001). Conclusions: Even in a non-epicenter region, the risk of delayed STEMI reperfusion significantly increased due to cumulative impact of multiple procedures prolongation.
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Mao et al. (2021) conducted an observational in ST-segment-elevation myocardial infarction (STEMI) (n=320). COVID-19 pandemic period vs. Pre-pandemic period (2019) was evaluated on Delayed primary percutaneous coronary intervention (FMC-to-W ≥ 120 min) (OR 7.040, 95% CI 3.610-13.729, p=<0.001). The COVID-19 pandemic was significantly associated with a higher risk of delayed primary percutaneous coronary intervention (OR 7.040) in STEMI patients, driven by cumulative prolongations in multiple reperfusion procedures.
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