Key result
COVID-19 pandemic linked to a ~119% increase in late STEMI presentations and longer door-to-balloon times.
Why the study?
The impact of the COVID-19 pandemic on STEMI patients in Japan remained unclear.
Does the COVID-19 pandemic increase treatment delays and mortality in STEMI patients?
Cohort (n=398)
No
Does the COVID-19 pandemic increase treatment delays and mortality in STEMI patients?
The COVID-19 pandemic caused significant delays in presentation and treatment for STEMI patients in Tokyo, with a trend toward increased in-hospital mortality.
STEMI presentation and treatment delays during COVID-19 merit vigilance in crises; leaves open whether patterns persist or affect outcomes in Japan.
Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door [241 (IQR: 70-926) vs. 128 (IQR: 66-493) minutes, p=0.028] and door-to-balloon [72 (IQR: 61-128) vs. 60 (IQR: 43-90) min, p<0.001] times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusion The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.
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Watanabe et al. (2021) conducted a cohort in ST-elevation Myocardial Infarction (STEMI) (n=398). COVID-19 pandemic vs. Pre-COVID-19 period was evaluated on Late presentation (onset-to-door time >24 hours) (p=<0.001). The COVID-19 pandemic was associated with a significant increase in late presentation for STEMI (26.5% vs. 12.1%) and longer door-to-balloon times compared to the pre-pandemic period.
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