Hospitalizations and in-hospital outcomes in patients with ST-elevation myocardial infarction during the coronavirus disease 2019 pandemic: The Albanian experience

Abstract

Objective: Global studies report a significant decline in ST-elevation myocardial infarction (STEMI) related hospitalization rates during the coronavirus disease 2019 (COVID-19) pandemic outbreak. However, there have been several divergent reports on hospital outcomes. In this study, we aim to investigate the impact of the COVID 19 outbreak on hospitalizations because of STEMI and in-hospital outcomes in Albania.

Methods: This was a retrograde study, collecting data for hospitalizations because of STEMI from March 9, (first COVID 19 case in our country) to April 30, 2020, (period of total lockdown) compared with the same period in 2019 at our center. The incidence rate ratio (IRR) was used to compare admissions because of STEMI and procedures and the risk ratio (RR) to compare mortality and other complication rates.

Results: Admissions for STEMI declined during the COVID-19 period from a total of 217 in 2019 to 156 in 2020 (-28.1%) representing IRR 0.719 (p=0.033). PCIs also reduced from 168 procedures in 2019 to 113 in 2020 (-33%), representing an IRR of 0.67, p=0.021. The time from symptom onset to arrival at our intensive care unit was significantly higher in 2020 compared to 2019 (925.6±1097 vs. 438.7±385 minutes, p<0.001). The STEMI death rate during the pandemic compared to the control period was significantly increased to 14.1% vs. 7.8% (RR=1.91 p=0.037, but with no significant increase in primary PCI-STEMI death rate (8.9% vs. 4.8% RR=1.85 p=0.217). Cardiogenic shock also increased during the pandemic to 21.2% from 12.4% in 2019 (RR=1.70 p=0.025).

Conclusion: Hospitalizations and revascularization procedures for STEMI significantly reduced during the COVID-19 pandemic. We identified a substantial increase in the STEMI mortality rate and cardiogenic shock during the pandemic outbreak. Delayed timely reperfusion intervention might be responsible for the increased risk for complications.

Figure 1

a) Weekly admission difference in percentage (percentage change during COVID-19 compared with the control period) assessed for ST-segment elevation myocardial infarction showing an important reduction in all admissions during the third to fifth weeks of the study compared with that in the control period. b) Weekly difference in percutaneous coronary interventions percentage (percentage change during COVID-19 and control periods) showing an important reduction during the third to fifth weeks of the study compared to that in the control period. c) Weekly difference in in-hospital mortality percentage (percentage change during COVID-19 and control periods) showing an important increase during the fourth week of the study compared to that in the control period.

Figure 2

a) Time from symptom onset to ICU presentation showed in percentage according to the presentation time; <6 h (early) in blue, 6–12 h (delayed) in orange, and >12 h (late) in gray. b) Cardiac troponin I at admission and c) ejection Fraction at discharge. In b and c, the mean values are reported, whereas the central line indicates the 50^th percentile (median value). The box contains values between the 25^th and 75^th percentiles, the whiskers denote the values between the 5^th and 95^th percentiles, whereas the dots beyond the whiskers are outlier values.