Key result
STEMI presentation during COVID-19 shows no significant difference in inpatient mortality versus pre-pandemic.
Why the study?
As SARS-CoV-2 continues to evolve, understanding its implications on STEMI care at a pandemic epicenter remained an ongoing clinical need.
Did presentation during the COVID-19 pandemic affect AMI team activations, door-to-balloon times, length of stay, and inpatient mortality in patients with STEMI compared to the pre-pandemic period?
Cohort (n=183)
No
Did presentation during the COVID-19 pandemic affect AMI team activations, door-to-balloon times, length of stay, and inpatient mortality in patients with STEMI compared to the pre-pandemic period?
At a New York epicenter hospital, STEMI activation volumes, length of stay, and inpatient mortality remained similar during the initial 2020 COVID-19 wave compared to 2019, despite a trend toward longer door-to-balloon times.
Answers are grounded in this paper and cite their sources.
STEMI inpatient mortality remained similar during the initial COVID wave; leaves open whether modest door-to-balloon delays affect outcomes in broader settings.
Background/purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a highly contagious and lethal virus, devastating healthcare systems throughout the world. Following a period of stability, the coronavirus disease 2019 (COVID-19) pandemic appears to be re-intensifying globally. As the virus continues to evolve, so does our understanding of its implications on ST-segment elevation myocardial infarction (STEMI). We sought to describe a single center STEMI experience at one of the epicenters during the COVID-19 pandemic. Methods/materials We conducted a retrospective, observational study comparing STEMI patients during the pandemic period (March 1, 2020 to August 31, 2020) to those with STEMI during the pre-pandemic period (March 1, 2019 to August 31, 2019) at NYU Langone Hospital – Long Island, a tertiary care center in Nassau County, New York. Additionally, we describe our subset of COVID-19 patients with STEMI during the pandemic. Results The acute myocardial infarction (AMI) team was activated for a total of 183 patients during both periods. There were a similar number of AMI team activations during the pandemic period (n = 93) compared to the pre-pandemic period (n = 90). Baseline characteristics did not differ during both periods however, infection control measures and additional investigation were required to clarify the diagnosis during the pandemic, resulting in a signal towards longer door-to-balloon times (95.9 min vs. 74.4 min, p = 0.0587). We observed similar inpatient length of stay (LOS) (3.6 days vs. 5.0 days, p = 0.0901) and mortality (13.2% vs. 9.2%, p = 0.5876). There was a total of 6 COVID-19 positive patients who presented with STEMI, of which 4 were emergently taken to the cardiac catheterization laboratory with successful percutaneous coronary intervention (PCI) performed in 3 patients. The 2 patients who were not offered primary PCI expired, as both were treated medically, one with thrombolytics. Conclusions Our single center study, in New York, at one of the epicenters of the pandemic, demonstrated a similar number of AMI team activations, mimicking the seasonal variability seen in 2019, but with a signal towards longer door-to-balloon time. Despite this, inpatient LOS and mortality remained similar.
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Medranda et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=183). Presentation during the COVID-19 pandemic period (March 1, 2020 to August 31, 2020) vs. Presentation during the pre-pandemic period (March 1, 2019 to August 31, 2019) was evaluated on Inpatient mortality (p=0.5876). Presenting with STEMI during the COVID-19 pandemic vs pre-pandemic showed similar inpatient mortality and a signal toward longer door-to-balloon time.
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