Recovery From the Impact of COVID-19 on Treatment Times and Clinical Outcomes of Patients With ST-Segment Elevation Myocardial Infarction: An Interim Analysis

Authors

Abdelrahman Ali
Thomas Schirmer
Francis J Kiernan
Bryan Piccirillo
Joseph Ingrassia
Talhat Azemi
Immad Sadiq
Daniel B Fram
Asad Rizvi
Saurabh Joshi
Jeffrey Mather
Raymond G McKay

Publication Date

3-1-2023

Journal

The Texas Heart Institute Journal

DOI

10.14503/THIJ-22-7919

PMID

36913275

Publication Date(s)

March 2023

Language

English

PMCID

PMC10178640

PubMedCentral® Posted Date

3-13-2023

PubMedCentral® Full Text Version

Post-Print

Published Open-Access

yes

Keywords

Humans, ST Elevation Myocardial Infarction, Retrospective Studies, Pandemics, Time Factors, COVID-19, Percutaneous Coronary Intervention, Time-to-Treatment

Copyright

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Abstract

BACKGROUND: Previous studies have documented a negative impact of the COVID-19 pandemic on emergent percutaneous treatment of patients with ST-segment elevation myocardial infarction (STEMI), but few have examined recovery of healthcare systems in restoring prepandemic STEMI care.

METHODS: Retrospective analysis was performed of data from 789 patients with STEMI from a large tertiary medical center treated with percutaneous coronary intervention between January 1, 2019, and December 31, 2021.

RESULTS: For patients with STEMI presenting to the emergency department, median time from door to balloon was 37 minutes in 2019, 53 minutes in 2020, and 48 minutes in 2021 (P < .001), whereas median time from first medical contact to device changed from 70 to 82 to 75 minutes, respectively (P = .002). Treatment time changes in 2020 and 2021 correlated with median emergency department evaluation time (30 to 41 to 22 minutes, respectively; P = .001) but not median catheterization laboratory revascularization time. For transfer patients, median time from first medical contact to device changed from 110 to 133 to 118 minutes, respectively (P = .005). In 2020 and 2021, patients with STEMI had greater late presentation (P = .028) and late mechanical complications (P = .021), with nonsignificant increases in yearly in-hospital mortality (3.6% to 5.2% to 6.4%; P = .352).

CONCLUSION: COVID-19 was associated with worsening STEMI treatment times and outcomes in 2020. Despite improving treatment times in 2021, in-hospital mortality had not decreased in the setting of a persistent increase in late patient presentation and associated STEMI complications.