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. 2025 Jan;41(1):121-129.
doi: 10.6515/ACS.202501_41(1).20241021A.

Impact of the COVID-19 Pandemic on Door-to-Device Time Segments and Clinical Outcomes for STEMI Patients in Northern Taiwan

San-Fang Chou  1 , Chun-Yu Hsieh  2 , Kuang-Chau Tsai  3 , Yuan-Hung Liu  4   5 , Chieh-Min Fan  3 , Jie-Ren Mi Le  6 , Fu-Shan Jaw  6 , Chung-Ta Chang  3   7 , Shyh-Shyong Sim  3 , Yen-Wen Wu  4   8   9 , Ting-Li Tai  3 , Kuan-Chang Chen  4 , Yuan-Hui Wu  3   10 , Chien-Chieh Hsieh  6   3   7   11
Affiliations

Impact of the COVID-19 Pandemic on Door-to-Device Time Segments and Clinical Outcomes for STEMI Patients in Northern Taiwan

San-Fang Chou et al. Acta Cardiol Sin. 2025 Jan.

Abstract

Background: Prompt primary percutaneous coronary intervention (pPCI) is crucial for the prognosis and reduction of myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients. The Coronavirus Disease 2019 (COVID-19) pandemic had multifaceted impacts on healthcare. This study assessed the effects of the pandemic on pPCI procedures and clinical outcomes in emergency STEMI patients.

Methods: This retrospective, single-center study analyzed STEMI patients who underwent pPCI from February 2019 to January 2022. The COVID-19 pandemic was categorized into three periods: pre-COVID-19 (Period-I), early-pandemic (Period-II), and epidemic (Period-III). The impacts on Door-to-Device time, its segments, and clinical outcomes were analyzed using Statistical Package for the Social Sciences.

Results: A total of 404 STEMI patients were included, with a reduced number in Period-III. Compared to Period-I, the time intervals of Door-to-electrocardiogram (ECG), ECG-to-Cardiac Catheterization Laboratory Activation (CCLA), and CCLA-to-Cardiac Catheterization Laboratory Door in Period III were extended by 0.62 minutes (p = 0.006), 3.30 minutes (p = 0.009), and 9.65 minutes (p < 0.001), respectively. In contrast, the Angio-to-Device time was shorter in Period- II and III by 2.60 and 4.08 minutes (p < 0.001), respectively. Overall Door-to-Device time increased by 10.06 minutes (p < 0.001) in Period-III but decreased by 3.67 minutes in Period-II (p = 0.017). The odds of achieving a Door-to-Device time ≤ 90 minutes decreased by 70% in Period-III (p = 0.002). Clinical outcomes, including intensive care unit stay, hospital stay, in-hospital mortality, and 30-day readmission rate, remained stable across periods.

Conclusions: The COVID-19 pandemic had various effects on different segments of the Door-to-Device procedure, and they were influenced by the complex interplay between infection control measures and clinical workflow. The stability of clinical outcomes reflects the resilience and effective adaptations of the healthcare system during the pandemic.

Keywords: COVID-19; D2B; Door to Device; Percutaneous coronary intervention; ST-segment elevation myocardial infarction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart and definitions of the sequential intervals of Door-to-Device time in the primary percutaneous coronary intervention (PCI) procedure.
See this image and copyright information in PMC

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