Impact of COVID-19 pandemic on STEMI thrombolysis and Emergency Department's performance in a non-PCI capable tertiary hospital

Am J Emerg Med. 2022 Oct:60:9-14. doi: 10.1016/j.ajem.2022.07.021. Epub 2022 Jul 16.

Abstract

Introduction: Some guidelines had recommended "thrombolysis first" in ST-elevated myocardial infarction (STEMI) during the Coronavirus Disease 2019 (COVID-19) outbreak. The impact of COVID-19 solely on STEMI thrombolysis is lacking as most studies reported outcomes related to percutaneous coronary intervention (PCI) setting. Thus, this study aimed to assess the impact of the COVID-19 pandemic on STEMI thrombolysis outcomes and the Emergency Department's performance in a non-PCI capable centre.

Methods: This single-centre retrospective study analysed data on consecutive STEMI patients who received thrombolytic therapy from May 2019 to December 2020 (20 months) in a non-PCI capable tertiary hospital. Total population sampling was used in this study. We compared all patients' characteristics and outcomes ten months before and during the pandemic. Regression models were used to assess the impact of COVID-19 pandemic on door-to-needle time (DNT), mortality, bleeding events, and the number of overnight stays.

Results and discussion: We analysed 323 patients with a mean age of 52.9 ± 12.9 years and were predominantly male (n = 280, 88.9%). There was a 12.5% reduction in thrombolysis performed during the pandemic. No significant difference in timing from symptoms onset to thrombolysis and DNT was observed. In-hospital mortality was significantly higher during the pandemic (OR 2.02, 95% CI 1.02-4.00, p = 0.044). Bleeding events post thrombolysis remained stable and there was no significant difference in the number of overnight stays during the pandemic.

Conclusion: STEMI thrombolysis cases were reduced during the COVID-19 pandemic, with an inverse increase in mortality despite the preserved Emergency Department performance in timely thrombolysis.

Keywords: Asian; COVID-19; Emergency Department; STEMI; Streptokinase; Tenecteplase; Thrombolysis.

MeSH terms

  • Adult
  • Aged
  • COVID-19*
  • Emergency Service, Hospital
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Pandemics
  • Percutaneous Coronary Intervention* / methods
  • Retrospective Studies
  • ST Elevation Myocardial Infarction* / etiology
  • Tertiary Care Centers
  • Thrombolytic Therapy / methods
  • Treatment Outcome