Impact of Public Health Emergency Response to COVID-19 on Management and Outcome for STEMI Patients in Beijing-A Single-Center Historic Control Study

Abstract

Coronavirus disease 2019 (COVID-19) pandemic poses great challenge on public health globally. To clarify the impact of COVID-19 pandemic on in-hospital management and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in the nonepicenter. We enrolled consecutive STEMI patients who visited Fuwai Hospital from January to March, 2020 (N = 73) and also established a historical control including all consecutive STEMI patients in the same period of 2019 (N = 95). The primary outcome was defined as a composite endpoint of all-cause death, heart failure, cardiac shock, and cardiac arrest during hospitalization. Emergency response for COVID-19 resulted in a significant 77.6% reduction in the number of primary percutaneous coronary intervention, and a trend toward higher rate of primary composite endpoint (15.1% vs 11.6%, P = 0.51). COVID-19 pandemic results in a significant reduction in emergent reperfusion therapy, and a trend toward higher in-hospital adverse events risk.

FIG 1

Algorithm for management of STEMI patients for nondesignated hospital during COVID-19 epidemic. Medical staff should first evaluate whether COVID-19 can be excluded. For patients with a clinical small risk of COVID-19 infection, within 12 hours after symptom onset, with no contradiction and will possibly gain benefit, thrombolysis should be initiated immediately. For patients with thrombolytic contraindications or failed thrombolysis, a comprehensive benefit-risk assessment should be performed, and primary PCI should be started immediately when appropriate. For patients who cannot be ruled out for COVID-19 infection temporarily, all medical practice and COVID-19 screening should be conducted simultaneously. CAG, coronary angiography; COVID-19, coronavirus disease 2019; CT, computed tomography; ECG, electrocardiogram; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.

FIG 2

Impact of public health emergency response for COVID-19 on in-hospital outcome and treatment strategy. During COVID-19 pandemic, there was a 23.2% reduction in STEMI admission and 77.6% reduction in the number of primary PCI compared with historic control. PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.

FIG 3

Rate of adverse clinical events according to the year of hospitalization. MI, myocardial infarction.