COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction

Abstract

Background: The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate.

Methods: Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019.

Results: A total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797).

Conclusions: During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations.

Keywords: COVID-19; Door-to-balloon time; Percutaneous coronary intervention; ST-segment myocardial infarction; Treatment delay.

Fig. 1

Weekly ST-segment elevation myocardial infarction (STEMI) presentations (y‑axis, left) at the six participating centres and the number of hospitalisations for COVID-19 per week (y axis, right) from 1 January to 30 June 2020 (green line) and the corresponding period in 2019 (blue line) with the number of hospitalisations for COVID-19 in 2020 per week divided into three phases: pre-COVID phase (January-February), peak phase of COVID-19 in the Netherlands (March-April) and recovery phase (May-June). Bar graphs show the number of hospitalisations for COVID-19 in the Netherlands per week

Fig. 2

Box plot with different types of treatment delay in STEMI patients, comparing 2020 (COVID‑19 year; n = 717; 1 March to 30 June 2020) and 2019 (control period; n = 684; 1 March to 30 June 2019) and comparing highand low-endemic Dutch regions. a Patient delay = symptom onset—first medical contact. b Pre-hospital delay = first medical contact—arrival at PCI centre. c Door-to-balloon time = arrival at PCI centre—balloon inflation. d System delay = diagnosis—arterial access. e Total delay = symptom onset—arterial access. Values are median (IQR). N total number of patients. Delay times are in hours and minutes (hh:mm)