Key result
Patients presenting with STEMI in 2019 were significantly more likely to present with new onset angina (OR 2.23) compared to the COVID-19 lockdown period in 2020, with no significant difference in mortality.
Why the study?
Heart disease deaths increased during the COVID-19 pandemic, motivating an analysis of differences in STEMI presentation and potential outcome differences across 2019 to 2021.
Does presentation during the COVID-19 pandemic alter presentation characteristics and clinical outcomes in STEMI-activated patients?
Observational (n=1,001)
Yes
Does presentation during the COVID-19 pandemic alter presentation characteristics and clinical outcomes in STEMI-activated patients?
The COVID-19 pandemic altered the clinical presentation of STEMI patients and increased hospital length of stay and door-to-balloon times for non-survivors, without significantly increasing in-hospital STEMI mortality.
STEMI presentation during lockdown associated with less new-onset angina; leaves open whether pandemic altered care-seeking and warrants prospective confirmation.
Background and Aims: COVID-19 accounted for 12.2% deaths in the United States between March 2020 and October 2021, while heart disease deaths increased by 4.1% from 2019 to 2020. Our study analyses the differences in STEMI presentation from 2019-2021 and the potential outcome differences for years related to the COVID pandemic. Materials and Methods: A five-site retrospective study included 1001 STEMI-activated patients from January 2019 to December 2021. Patient demographics, risk factors, details of presentation and rationale for cath-lab activation were obtained as presentation details. Discharge status, intraprocedural death, major bleeding requiring transfusion, CABG status and indication, and time variables were obtained to evaluate outcomes. Results: For 1001 STEMI-activated patients, risk factors were cerebrovascular accident (CVA), for 2019 versus 2020. New onset angina was significant in 2019 and 2021 versus 2020. Worsening angina was significant in 2019 versus 2020 as rationale. Patients were similarly discharged alive and required similar transfusion. CABG indications were similar, with no between-year differences. There were not differences in time variables for patients Discharged-alive but for patients Discharged-deceased, there was increased procedure to discharge and length of stay (LOS) for 2021 versus 2020. Also, patients Discharged-alive in all three years had shorter mean door-to-balloon (DTB) times than patients who were discharged-deceased in 2021. Discussion: For COVID-relevant years 2019-2021, patients had similar backgrounds for a STEMI-activated presentation. Patients were 1.84 times more likely to have history of CVA when they presented in 2019 versus 2020. New onset angina was higher in 2019 and 2021 and worsening angina was significant in 2019. Therefore, 2019 seemed to be more representative of typical angina presentation, compared to COVID peak 2020 and afterward to 2021. There was no increased rate of deaths attributed to STEMI hospitalization indicating that patients may have delayed to seek care, possibly attributed to the impact of the COVID lockdown or died at home related to cardiac event rather than seek medical care. For secondary outcomes, transfusion was equally likely. There were delays in procedure to discharge, LOS, and DTB times for 2021 versus 2020, which may be related to overall resource limitations.
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Rebekah Lantz (2022) conducted an observational in ST-segment Elevation Myocardial Infarction (STEMI) (n=1,001). STEMI presentation in 2019 (pre-COVID) vs. STEMI presentation in 2020 (peri-COVID lockdown) was evaluated on New onset angina as rationale for STEMI presentation (OR 2.23, 95% CI 1.42-3.50, p=0.0005). Patients presenting with STEMI in 2019 were significantly more likely to present with new onset angina (OR 2.23) compared to the COVID-19 lockdown period in 2020, with no significant difference in mortality.
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