Key result
COVID-19 outbreak linked to a ~111% higher risk of major in-hospital events for MI patients.
Why the study?
The COVID-19 pandemic placed stress on healthcare systems and altered human behavior and resource allocation, which could potentially cause treatment delays and adversely affect outcomes in MI patients.
Does admission during the COVID-19 outbreak worsen in-hospital outcomes in patients with acute myocardial infarction?
Cross-Sectional (n=149)
No
Does admission during the COVID-19 outbreak worsen in-hospital outcomes in patients with acute myocardial infarction?
Absolute Event Rate: 29.7% vs 14.1%
p-value: p=.02
The COVID-19 outbreak and associated emergency response measures were associated with delayed presentation and worse in-hospital outcomes for patients with acute myocardial infarction.
May signal need for outbreak preparedness in MI care; leaves open whether delays or confounders explain excess events.
OBJECTIVE: To determine whether COVID-19 may adversely affect outcome of myocardial infarction (MI) patients in Hong Kong, China. BACKGROUND: The COVID-19 pandemic has infected thousands of people and placed enormous stress on healthcare system. Apart from being an infectious disease, it may affect human behavior and healthcare resource allocation which potentially cause treatment delay in MI. METHODS: This was a single center cross-sectional observational study. From November 1, 2019 to March 31, 2020, we compared outcome of patients admitted for acute ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) before (group 1) and after (group 2) January 25, 2020 which was the date when Hong Kong hospitals launched emergency response measures to combat COVID-19. RESULTS: There was a reduction in daily emergency room attendance since January 25, 2020 (group 1,327/day vs. group 2,231/day) and 149 patients with diagnosis of MI were included into analysis (group 1 N = 85 vs. group 2 N = 64). For STEMI, patients in group 2 tended to have longer symptom-to-first medical contact time and more presented out of revascularization window (group 1 27.8 vs. group 2 33%). The primary composite outcome of in-hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) was significantly worse in group 2 (14.1 vs. 29.7%, p = .02). CONCLUSIONS: More MI patients during COVID-19 outbreak had complicated in-hospital course and worse outcomes. Besides direct infectious complications, cardiology community has to acknowledge the indirect effect of communicable disease on our patients and system of care.
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Tam et al. (2020) conducted a cross-sectional in myocardial infarction (n=149). COVID-19 outbreak vs. Pre-COVID-19 outbreak period was evaluated on composite outcome of in-hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) (p=.02). The COVID-19 outbreak was associated with worse in-hospital outcomes (death, cardiogenic shock, VT/VF, and MCS use) in MI patients compared to the pre-outbreak period (29.7% vs 14.1%, p=0.02).
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