Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients.

Objectives: This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol on the treatment and prognosis of STEMI patients in China.

Methods: Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients.

Results: The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center's modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable.

Conclusions: There were reductions in STEMI patients' access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.

Keywords: COVID-19; ST-segment elevation myocardial infarction; chest pain center; primary percutaneous coronary intervention; thrombolysis.

Graphical abstract

Central Illustration

Impact of the Coronavirus Disease-2019 Outbreak Period on ST-Segment Elevation Myocardial Infarction Cases, Treatment, and Prognosis (A, B) The estimated means of number of ST-segment elevation myocardial infarction (STEMI) cases per Chest Pain Center (CPC) per week and the estimated means of time from symptom onset to first medical contact (S-to-FMC) (in hours) before and during the outbreak, in Hubei and in other provinces. (C, D) The decrease of proportion of STEMI cases undergoing primary percutaneous coronary intervention (PPCI) and the increase of those undergoing thrombolysis during the coronavirus disease-2019 (COVID-19) outbreak. (E) The estimated odds ratios of the independent variable “COVID-19 Outbreak Period” (January 24, 2020 to February 20, 2020) and corresponding confidence intervals in logistic regression models with 8 intermediate and endpoint outcome variables. OR = odds ratio; Wk = week.