Outcomes of STEMI Patients During the COVID-19 Pandemic in China

Quick Takes

  • There were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.
  • The in-hospital mortality and in-hospital heart failure rate of STEMI patients increased during the COVID-19 outbreak in China, while the rate of in-hospital hemorrhage remained stable.
  • Additional studies are indicated to assess optimal treatment strategies of STEMI patients to further evaluate the effects of different strategies and improve outcomes during pandemics and challenging times.

Study Questions:

What is the impact of the coronavirus disease 2019 (COVID-19) outbreak and China Chest Pain Center (CCPC)’s modified STEMI protocol on the treatment and prognosis of ST-segment elevation myocardial infarction (STEMI) patients in China?

Methods:

The investigators analyzed how the COVID-19 outbreak and CCPC’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, in-hospital mortality, and in-hospital heart failure for STEMI patients based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers (CPCs) in China between December 27, 2019 and February 20, 2020. The authors estimated multivariate linear regression models for continuous outcome variables and logistic regression models for dichotomous outcome variables, except for using a mixed-effect model for weekly STEMI cases to account for dependence among the weekly numbers reported by the same CPC.

Results:

The COVID-19 outbreak reduced the number of STEMI cases reported to CCPCs. Consistent with CCPC’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention (PPCI) declined, while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 minutes for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable.

Conclusions:

This study reports that the COVID-19 outbreak reduced STEMI patients’ probability of accessing care and receiving timely reperfusion.

Perspective:

The authors concluded that there were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China. Concordant with CCPC’s modified STEMI protocol, there was an increase in the proportion of STEMI cases undergoing thrombolysis and a decrease in that of PPCI during the outbreak. Furthermore, the in-hospital mortality and in-hospital heart failure rate of STEMI patients increased during the COVID-19 outbreak in China, while the rate of in-hospital hemorrhage remained stable. Additional studies are indicated to assess optimal treatment strategies of STEMI patients to further evaluate the effects of different strategies and improve outcomes during pandemics and challenging times.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and ACS

Keywords: Acute Coronary Syndrome, Chest Pain, Coronavirus, COVID-19, Heart Failure, Hospital Mortality, Mechanical Thrombolysis, Myocardial Infarction, Myocardial Reperfusion, Pain Clinics, Percutaneous Coronary Intervention, Secondary Prevention, severe acute respiratory syndrome coronavirus 2, ST Elevation Myocardial Infarction


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