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Observational Study
. 2022 Feb;53(2):321-334.
doi: 10.1007/s11239-021-02487-3. Epub 2021 May 29.

Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial ınfarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial ınfarction registry)

Tuncay Kiris  1 , Eyüp Avci  2 , Tuba Ekin  3 , Didar Elif Akgün  2 , Mücahit Tiryaki  4 , Arafat Yidirim  5 , Kutluhan Hazir  6 , Bektaş Murat  7 , Mehtap Yeni  8 , Rojhad Altindag  9 , Sefa Gül  10 , Baran Arik  11 , Tuncay Güzel  12 , Selda Murat  13 , Ahmet Oz  14 , Mustafa Karabacak  15 , Zihni Aktas  16 , Tarik Yildirim  2 , Baris Kilicaslan  6 , Asim Oktay Ergene  3
Affiliations
Observational Study

Impact of COVID-19 outbreak on patients with ST-segment elevation myocardial ınfarction (STEMI) in Turkey: results from TURSER study (TURKISH St-segment elevation myocardial ınfarction registry)

Tuncay Kiris et al. J Thromb Thrombolysis. 2022 Feb.

Abstract

Objective: We aimed to investigate both the impact of COVID-19 pandemic on ST-segment elevation myocardial infarction (STEMI) admission, and demographic, angiographic, procedural characteristics, and in-hospital clinical outcomes of patients with COVID-19 positive STEMI in Turkey.

Methods: This was a multi-center and cross-sectional observational study. The study population included 1788 STEMI patients from 15 centers in Turkey. The patients were divided into two groups: COVID-19 era (March 11st-May 15st, 2020; n = 733) or pre- COVID-19 era group (March 11st-May 15st, 2019; n = 1055). Also, the patients in COVID-19 era were grouped as COVID-19 positive (n = 65) or negative (n = 668).

Results: There was a 30.5% drop in STEMI admission during COVID-19 era in comparison to pre-COVID-19 era. The patients admitted to the medical centers during COVID-19 era had a longer symptom-to-first medical contact time [120 (75-240) vs. 100 (60-180) minutes, p < 0.001]. COVID-19 positive STEMI patients had higher thrombus grade and lower left ventricular ejection fraction compared to COVID-19 negative patients. COVID-19 positive patients had higher mortality (28% vs. 6%, p < 0.001) and cardiogenic shock (20% vs. 7%, p < 0.001) rates compared with those without COVID-19. Matching based on propensity scores showed higher mortality and high thrombus grade in STEMI patients who were infected by SARS-COV-2 (each p < 0.05).

Conclusions: We detected significantly lower STEMI hospitalization rates and significant delay in duration of symptom onset to first medical contact in the context of Turkey during the COVID-19 outbreak. Moreover, high thrombus grade and mortality were more common in COVID-19 positive STEMI patients.

Keywords: COVID-19; Intervention; Mortality; Primary percutaneous coronary; SARS-CoV2; ST elevation myocardial infarction.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Fig. 1
Fig. 1
Flow diagram of patient recruitment
Fig. 2
Fig. 2
Comparison of ST elevation hospitalizations in COVID-19 era and pre-COVID-19 era
Fig. 3
Fig. 3
Symptoms- to first medical contact time (FMC) for acute ST-segment elevation. myocardial infarction (STEMI)
Fig. 4
Fig. 4
In-hospital outcomes include mortality, cardiogenic shock and baseline thrombus grade for pre-COVID-19 era and COVID-19 era
Fig. 5
Fig. 5
In-hospital outcomes include mortality, cardiogenic shock and baseline thrombus grade for non-COVID and COVID groups before matching
Fig. 6
Fig. 6
In-hospital outcomes include mortality, cardiogenic shock and baseline thrombus grade for non-COVID and COVID groups after matching
Fig. 7
Fig. 7
Positive correlation between thrombus grade and d-dimer levels in COVID-19 positive STEMI patients
See this image and copyright information in PMC

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