The COVID-19 outbreak in Austria was associated with a significant increase in total ischemic times for STEMI patients, rising from 164 minutes to 275 minutes (p=0.006).
Observational (n=163)
Yes
Does the COVID-19 pandemic outbreak increase ischemic times and delay treatment in patients with STEMI?
The COVID-19 pandemic was associated with a 1.7-fold increase in total ischemic times for STEMI patients, driven primarily by patient-related delays rather than in-hospital door-to-balloon times.
Absolute Event Rate: 275% vs 164%
p-value: p=0.006
Coronavirus disease 19 (COVID-19) and its associated restrictions could affect ischemic times in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to investigate the influence of the COVID-19 outbreak on ischemic times in consecutive all-comer STEMI patients. We included consecutive STEMI patients (n = 163, median age: 61 years, 27% women) who were referred to seven tertiary care hospitals across Austria for primary percutaneous coronary intervention between 24 February 2020 (calendar week 9) and 5 April 2020 (calendar week 14). The number of patients, total ischemic times and door-to-balloon times in temporal relation to COVID-19-related restrictions and infection rates were analyzed. While rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%)), total ischemic times increased from 164 (interquartile range (IQR): 107–281) min (calendar week 9/10) to 237 (IQR: 141–560) min (calendar week 11/12) and to 275 (IQR: 170–590) min (calendar week 13/14) (p = 0.006). Door-to-balloon times were constant (p = 0.60). There was a significant difference in post-interventional Thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients treated during calendar week 9/10 (97%), 11/12 (84%) and 13/14 (81%; p = 0.02). Rates of in-hospital death and re-infarction were similar between groups (p = 0.48). Results were comparable when dichotomizing data on 10 March and 16 March 2020, when official restrictions were executed. In this cohort of all-comer STEMI patients, we observed a 1.7-fold increase in ischemic time during the outbreak of COVID-19 in Austria. Patient-related factors likely explain most of this increase. Counteractive steps are needed to prevent further cardiac collateral damage during the ongoing COVID-19 pandemic.
Reinstadler et al. (Fri,) conducted a observational in ST-segment elevation myocardial infarction (STEMI) (n=163). COVID-19 pandemic outbreak vs. Early outbreak period (calendar week 9/10) was evaluated on Total ischemic times (p=0.006). The COVID-19 outbreak in Austria was associated with a significant increase in total ischemic times for STEMI patients, rising from 164 minutes to 275 minutes (p=0.006).