The Impact of the Early COVID-19 Pandemic on ST-Segment Elevation Myocardial Infarction Presentation and Outcomes-A Systematic Review and Meta-Analysis

Abstract

Background: The influence of the early COVID-19 pandemic on non-COVID-19 emergencies is uncertain. We conducted a systematic review and a meta-analysis to evaluate the impact of the first months of the COVID-19 pandemic on the presentation, management, and prognosis of patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods: We searched the PubMed, Scopus, and Embase databases from January to August 2020. A meta-analysis of studies comparing the profile, STEMI severity at presentation, reperfusion delay, and in-hospital mortality for patients presenting before and during the early COVID-19 pandemic was conducted. Fifteen cross-sectional observational studies including 20,528 STEMI patients from the pre-COVID period and 2190 patients diagnosed and treated during the first months of the COVID-19 pandemic met the inclusion criteria. Results: Patients presenting with STEMI during the pandemic were younger and had a higher comorbidity burden. The time interval between symptoms and first medical contact increased from 93.22 ± 137.37 min to 142 ± 281.60 min (p < 0.001). Door-to-balloon time did not differ significantly between the two periods (p = 0.293). The pooled odds ratio (OR) for low left ventricular ejection fraction at presentation during the pandemic was 2.24 (95% confidence interval (CI) 1.54−3.26) and for a presentation delay >24 h was 2.9 (95% CI 1.54−5.45) relative to before the pandemic. In-hospital mortality did not increase significantly during the outbreak (p = 0.97). Conclusion: During the first months of the COVID-19 pandemic, patients presenting with STEMI were addressed later in the course of the disease with more severe left ventricular impairment. In-hospital emergency circuits and care functioned properly with no increase in door-to-balloon time and early mortality.

Keywords: door-to-balloon time; left ventricular ejection fraction; mortality; symptoms-to-first-medical-contact time; total ischemic time; troponin I.

Figure 1

PRISMA flow chart of the selection process.

Figure 2

Percentage variation of the number of patients presenting daily during the pandemic compared to the period before.

Figure 3

Forest plots for symptoms-to-FMC time.

Figure 4

Forest plots for door-to-balloon time.

Figure 5

Forest plots for total ischemic time.

Figure 6

Forest plots for troponin-I level.

Figure 7

Forest plots for LVEF at presentation.

Figure 8

Forest plots for presentation delay >24 h.

Figure 9

Forest plots for In-hospital mortality.