Decreased door-to-balloon time in patients with ST-segment elevation myocardial infarction during the early COVID-19 pandemic in South Korea: An observational study

Abstract

The coronavirus disease 2019 (COVID-19) resulted in a marked decrease in the number of patient visits for acute myocardial infarction and delayed patient response and intervention in several countries. This study evaluated the effect of the COVID-19 pandemic on the number of patients, patient response time (pain-to-door), and intervention time (door-to-balloon) for patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Patients with STEMI or NSTEMI visiting a hospital in South Korea who underwent primary coronary intervention during the COVID-19 pandemic (January 29, 2020, to December 31, 2020) were compared with those in the equivalent period from 2018 to 2019. Patient response and intervention times were compared for the COVID-19 pandemic window (2020) and the equivalent period from 2018 to 2019. We observed no decrease in the number of patients with STEMI (P = .88) and NSTEMI (P = 1.00) during the COVID-19 pandemic compared to that in the previous years. Patient response times (STEMI: P = .39; NSTEMI: P = .59) during the overall COVID-19 pandemic period did not differ significantly. However, we identified a significant decrease in door-to-balloon time among patients with STEMI (14%; P < .01) during the early COVID-19 pandemic. We found that the number of patients with STEMI and NSTEMI was consistent during the COVID-19 pandemic and that no time delays in patient response and intervention occurred. However, the door-to-balloon time among patients with STEMI significantly reduced during the early COVID-19 pandemic, which could be attributed to decreased emergency care utilization during the early pandemic.

Figure 1.

COVID-19 cases and estimated rate ratio of hospitalized patients with STEMI and NSTEMI. (A) The weekly count of local COVID-19 cases nationwide (black bar) and in the North Jeolla province (solid blue line). (B) The 2018/2019–2020 estimated admission rate ratio of patients with STEMI (brown bar) and NSTEMI (blue bar) during the 3 different epidemic periods of COVID-19. The bar indicates 95% confidence intervals. The study period included Period-1 (epidemiological week 4–19), Period-2 (week 20–33), and Period-3 (week 34–52). COVID-19, coronavirus disease 2019, NSTEMI = non-ST-segment elevation myocardial infarction, STEMI = ST-segment elevation myocardial infarction.

Figure 2.

Pain-to-door and door-to-reperfusion times of patients with STEMI and NSTEMI during 3 different periods. The study period included Period-1 (epidemiological week of 4–19), Period-2 (week of 20–33), and Period-3 (week of 34–52). NSTEMI = non-ST-segment elevation myocardial infarction, STEMI = ST-segment elevation myocardial infarction.