Impact of COVID-19 pandemic on STEMI care: An expanded analysis from the United States

Abstract

Objective: To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care.

Background: We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data.

Methods: Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC.

Results: Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p < .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p < .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05).

Conclusions: The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI.

Keywords: COVID-19; ST-elevation myocardial infarction; STEMI.

FIGURE 1

Changes in cardiac catheterization laboratory ST‐elevation myocardial infarction activations for each program (gray lines) relative to their respective mean BC volumes (Panel A) and Changes in cardiac catheterization laboratory ST‐elevation myocardial infarction activations according to geographic regions (gray lines) relative to their respective BC volumes (Panel B). The purple line represents the overall median. The band represents interquartile ranges [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

A dumbbell plot of Z‐scores showing changes in cardiac catheterization laboratory ST‐elevation myocardial infarction activations for each program. Units are standard deviations from their BC means, for example, Z‐score = 0 indicates that the volume at a given month in 2020 is identical to the mean BC volume. A negative Z‐score indicates a decline in units of standard deviations from their mean BC volumes. All programs saw a decline in March 2020 (Z‐scores marked by purple dots are all negative) with some recovering in April to nearly 2019 volumes (e.g., Iowa, Christ Hospital, Northwell, Swedish) and others either nearly unchanged (e.g., NY Presbyterian, MHI, MGH) or worsening (Prairie, Delray, BHC, U Penn, San Diego). BC, before COVID‐19 [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Changes in cardiac catheterization laboratory ST‐elevation myocardial infarction activations leading to angiographies for each program (gray lines) (Panel A) and leading to percutaneous coronary intervention (Panel B) relative to their respective average BC volumes. The purple line represents the overall median. The band represents interquartile ranges. BC, before COVID‐19 [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Changes in median door to balloon times for each program (gray lines) relative to their respective average BC volumes. The purple line represents the overall median. The band represents interquartile ranges. BC, before COVID‐19 [Color figure can be viewed at wileyonlinelibrary.com]