Who Has Seen Patients With ST-Segment-Elevation Myocardial Infarction? First Results From Italian Real-World Coronavirus Disease 2019

Abstract

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment-elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub, and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.

Keywords: acute coronary syndrome; complications; coronavirus; interstitial pneumonia; percutaneous coronary intervention.

Figure 1. Left ventricular ejection fraction (LVEF) at baseline and discharge of patients with ST‐segment–elevation myocardial infarction of March 2019 and March 2020.

Data are expressed as median and interquartile range (IQR). The baseline and discharge median and IQR of LVEF in March 2019 was 42% (IQR, 37%–47%) and 48% (IQR, 42%–55%), respectively. The baseline and discharge median and IQR of LVEF in March 2020 was 35% (IQR, 32.5%–42.5%) and 35% (IQR, 35%–40%), respectively. The median of delta (∆) between baseline and discharge LVEF in patients of 2019 is 5 (IQR, 0–8); and in patients of 2020, 0 (IQR, 0–2.5). The difference was 3 (95% CI, 0–5; P=0.011).