Effect of the COVID-19 Pandemic on Treatment Delays in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

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.

Keywords: Coronavirus disease 2019; ST-segment elevation myocardial infarction; total ischemic time.

Figure 1

Flow chart of the study. NSTEMI = non-ST-elevation myocardial infarction.

Figure 2

COVID-19 hospital admissions for STEMI and treatment delays. (A) Official statistics of all documented laboratory-confirmed cases of COVID-19 in Austria during the study period; (B) number of STEMI admissions compared between calendar week 9 and 10 (group 1), calendar week 11 and 12 (group 2), and calendar week 13 and 14 (group 3); (C) total ischemic time and door-to-balloon time of STEMI patients treated in calendar week 9 and 10 (group 1), calendar week 11 and 12 (group 2), and calendar week 13 and 14 (group 3). Abbreviations: STEMI = ST-elevation myocardial infarction; COVID-19 = coronavirus disease 2019.

Figure 2

COVID-19 hospital admissions for STEMI and treatment delays. (A) Official statistics of all documented laboratory-confirmed cases of COVID-19 in Austria during the study period; (B) number of STEMI admissions compared between calendar week 9 and 10 (group 1), calendar week 11 and 12 (group 2), and calendar week 13 and 14 (group 3); (C) total ischemic time and door-to-balloon time of STEMI patients treated in calendar week 9 and 10 (group 1), calendar week 11 and 12 (group 2), and calendar week 13 and 14 (group 3). Abbreviations: STEMI = ST-elevation myocardial infarction; COVID-19 = coronavirus disease 2019.