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Meta-Analysis
. 2021 Jul-Aug;73(4):404-412.
doi: 10.1016/j.ihj.2021.06.009. Epub 2021 Jun 25.

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

William Kamarullah  1 , Adelia Putri Sabrina  2 , Marthin Alexander Rocky  3 , Darius Revin Gozali  4
Affiliations
Meta-Analysis

Investigating the implications of COVID-19 outbreak on systems of care and outcomes of STEMI patients: A systematic review and meta-analysis

William Kamarullah et al. Indian Heart J. 2021 Jul-Aug.

Abstract

Introduction: There has been a concern whether the decrease in ST-segment elevation myocardial infarction (STEMI) cases during the COVID-19 pandemic era is related to unsatisfactory performance of STEMI systems of care as well as worsening of the clinical outcomes in STEMI patients. Thus, our meta-analysis was conducted to evaluate this matter.

Methods: We compared the predetermined variables in this meta-analysis during the early and late pandemic. Using a combination of adapted search terms to fit the requirements of several search engines (PubMed, EuropePMC, SCOPUS, ProQuest, and EBSCOhost), we reviewed all observational studies citing our outcomes of interest before and during the outbreak.

Results: Thirty-five records comprising a total of 62,247 participants were identified. Overall, our meta-analysis showed that there was a huge reduction of nearly 80% for STEMI admission during the outbreak (n = 10,263) in contrast to before the outbreak period (n = 51,984). STEMI patients who were admitted during the outbreak received less primary PCI and had longer symptom-to-FMC (first medical contact) time along with prolonged door-to-balloon (DTB) time. A decrease in the achievement of final TIMI (thrombolysis in myocardial infarction) 3 flow after primary PCI was also observed in this study. However, the number of in-hospital mortality was similar between two groups.

Conclusion: There was a decrease in the STEMI care performance and worsening of clinical outcomes in STEMI patients, especially in the early pandemic period. Overall, concise health services must be implemented following a responsibility to obey health protocols to deliver high-quality services related to STEMI systems of care amidst the global pandemic.

Keywords: COVID-19; Outcomes; Pandemic; Performance; STEMI; Systems of care.

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Conflict of interest statement

Declaration of competing interest None declared.

Figures

Fig. 1
Fig. 1
Flow chart of study selection.
Fig. 2
Fig. 2
(A) Forest plot and (B) funnel plot regarding symptom-to-FMC time between pre-pandemic and pandemic period.
Fig. 3
Fig. 3
(A) Forest plot and (B) funnel plot regarding the amount of performed primary PCI between pre-pandemic and pandemic period.
Fig. 4
Fig. 4
(A) Forest plot and (B) funnel plot regarding door-to-balloon time between pre-pandemic and pandemic period.
Fig. 5
Fig. 5
(A) Forest plot and (B) funnel plot regarding final TIMI 3 flow between pre-pandemic and pandemic period.
Fig. 6
Fig. 6
(A) Forest plot and (B) funnel plot regarding mortality between pre-pandemic and pandemic period.
See this image and copyright information in PMC

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