Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI

J Am Coll Cardiol. 2020 Nov 17;76(20):2321-2330. doi: 10.1016/j.jacc.2020.09.546.

Abstract

Background: The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality.

Objectives: The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment.

Methods: This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality.

Results: A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic.

Conclusions: The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).

Keywords: COVID-19; STEMI; primary angioplasty.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Coronavirus Infections*
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pandemics*
  • Percutaneous Coronary Intervention / statistics & numerical data*
  • Pneumonia, Viral*
  • Registries*
  • Retrospective Studies
  • ST Elevation Myocardial Infarction / mortality*
  • ST Elevation Myocardial Infarction / therapy

Supplementary concepts

  • COVID-19

Associated data

  • ClinicalTrials.gov/NCT04412655