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Observational Study
. 2020 Dec;73(12):994-1002.
doi: 10.1016/j.rec.2020.08.002. Epub 2020 Sep 8.

Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience

[Article in English, Spanish]
Oriol Rodríguez-Leor  1 , Belén Cid-Álvarez  2 , Armando Pérez de Prado  3 , Xavier Rossello  4 , Soledad Ojeda  5 , Ana Serrador  6 , Ramón López-Palop  7 , Javier Martín-Moreiras  8 , José Ramón Rumoroso  9 , Ángel Cequier  10 , Borja Ibáñez  11 , Ignacio Cruz-González  8 , Rafael Romaguera  10 , Raúl Moreno  12 ; Working Group on the Infarct Code of the Interventional Cardiology Association of the Spanish Society of Cardiology Investigators; Manuel Villa  13 , Rafael Ruíz-Salmerón  14 , Francisco Molano  15 , Carlos Sánchez  16 , Erika Muñoz-García  17 , Luís Íñigo  18 , Juan Herrador  19 , Antonio Gómez-Menchero  20 , Antonio Gómez-Menchero  21 , Juan Caballero  22 , Soledad Ojeda  23 , Mérida Cárdenas  24 , Livia Gheorghe  25 , Jesús Oneto  26 , Francisco Morales  27 , Félix Valencia  28 , José Ramón Ruíz  29 , José Antonio Diarte  30 , Pablo Avanzas  31 , Juan Rondán  32 , Vicente Peral  33 , Lucía Vera Pernasetti  34 , Julio Hernández  35 , Francisco Bosa  36 , Pedro Luís Martín Lorenzo  37 , Francisco Jiménez  38 , José M de la Torre Hernández  39 , Jesús Jiménez-Mazuecos  40 , Fernando Lozano  41 , José Moreu  42 , Enrique Novo  43 , Javier Robles  44 , Javier Martín Moreiras  45 , Felipe Fernández-Vázquez  46 , Ignacio J Amat-Santos  47 , Joan Antoni Gómez-Hospital  48 , Joan García-Picart  49 , Bruno García Del Blanco  50 , Ander Regueiro  51 , Xavier Carrillo-Suárez  52 , Helena Tizón  53 , Mohsen Mohandes  54 , Juan Casanova  55 , Víctor Agudelo-Montañez  56 , Juan Francisco Muñoz  57 , Juan Franco  58 , Roberto Del Castillo  59 , Pablo Salinas  60 , Jaime Elizaga  61 , Fernando Sarnago  62 , Santiago Jiménez-Valero  63 , Fernando Rivero  64 , Juan Francisco Oteo  65 , Eduardo Alegría-Barrero  66 , Ángel Sánchez-Recalde  67 , Valeriano Ruíz  68 , Eduardo Pinar  69 , Eduardo Pinar  70 , Ana Planas  71 , Bernabé López Ledesma  72 , Alberto Berenguer  73 , Agustín Fernández-Cisnal  74 , Pablo Aguar  75 , Francisco Pomar  76 , Miguel Jerez  77 , Francisco Torres  78 , Ricardo García  79 , Araceli Frutos  80 , Juan Miguel Ruíz Nodar  81 , Koldobika García  82 , Roberto Sáez  83 , Alfonso Torres  84 , Miren Tellería  85 , Mario Sadaba  86 , José Ramón López Mínguez  87 , Juan Carlos Rama Merchán  88 , Javier Portales  89 , Ramiro Trillo  90 , Guillermo Aldama  91 , Saleta Fernández  92 , Melisa Santás  93 , María Pilar Portero Pérez  94
Affiliations
Observational Study

Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience

[Article in English, Spanish]
Oriol Rodríguez-Leor et al. Rev Esp Cardiol (Engl Ed). 2020 Dec.

Abstract
in English, Spanish

Introduction and objectives: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.

Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.

Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.

Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Introducción y objetivos: El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no está claro. El objetivo de este estudio es evaluar los cambios en el tratamiento del IAMCEST durante el brote de COVID-19.

Métodos: Se utilizó un registro multicéntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las características de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes según se los hubiera tratado antes o durante la COVID-19.

Resultados: Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusión (más del 94% tratados con angioplastia primaria). El tiempo de isquemia fue más largo durante la COVID-19 (233 [150-375] frente a 200 [140-332] min; p < 0,001), sin diferencias en el tiempo primer contacto médico-reperfusión. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta = 1,50; IC95%, 1,07-2,11; p < 0,001); esta asociación se mantuvo tras ajustar por factores de confusión (OR ajustada = 1,88; IC95%, 1,12-3,14; p = 0,017). La incidencia de infección confirmada por SARS-CoV-2 fue del 6,3%.

Conclusiones: El brote de COVID-19 ha implicado una disminución en el número de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los síntomas y la reperfusión y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusión. La combinación de infección por SARS-CoV-2 e IAMCEST fue relativamente infrecuente.

Keywords: Angioplastia primaria; COVID-19; IAMCEST; Primary angioplasty; Red de atención al infarto; STEMI; STEMI network.

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Figures

Figure 1
Figure 1
Patient flowchart. NSTEMI, non-ST-segment elevation acute myocardial infarction, PCI, percutaneous coronary intervention; STEMI, non-ST-segment elevation acute myocardial infarction.
Figure 2
Figure 2
Absolute number of primary percutaneous coronary interventions per day during both time periods and the official number of confirmed COVID-19 cases. Numbers of confirmed COVID-19 cases are according to official Spanish government data. PCI, percutaneous coronary intervention.
Figure 3
Figure 3
COVID-19 diagnostic path. Patients were categorized on admission according to their COVID-19 status into 4 groups: unknown; no symptoms compatible with COVID-19 and no previous polymerase chain reaction (PCR) test; symptoms compatible with COVID-19 but no previous PCR test; and previous positive PCR test. Although a PCR assay needs to be performed at admission in all patients, it should be noted that PCR was not available in many facilities at the beginning of the pandemic, when this study was carried out.
Figure 4
Figure 4
Time intervals between symptom onset and reperfusion.
See this image and copyright information in PMC

Comment in

  • Myocardial infarction in times of COVID-19.
    Ibáñez B. Ibáñez B. Rev Esp Cardiol (Engl Ed). 2020 Dec;73(12):975-977. doi: 10.1016/j.rec.2020.09.023. Epub 2020 Oct 31. Rev Esp Cardiol (Engl Ed). 2020. PMID: 33139226 Free PMC article. No abstract available.

References

    1. World Health Organization. Coronavirus disease 2019 situation report. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio.... Accessed 22 Jul 2020.
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