STEMI patients in China experienced delayed treatment and increased rates of in-hospital mortality and heart failure (HF) during the COVID-19 pandemic, according to a study published Aug. 19 in the Journal of the American College of Cardiology.

Dingcheng Xiang, MD, et al., analyzed data of 28,189 STEMI patients admitted to 1,372 chest pain centers in China between Dec. 27, 2019, and Feb. 20, 2020. Specifically, the researchers looked the impact of COVID-19 in Hubei province, where the outbreak was centered in China, on four variables: access to care; reperfusion strategy (primary PCI, thrombolysis or conservative therapy); time to reperfusion; and in-hospital mortality, HF and hemorrhage. During the COVID-19 outbreak, on Jan. 23, 2020, the China Chest Pain Center Executive Committee modified its STEMI protocol to recommend thrombolysis as the preferred reperfusion strategy for STEMI patients whose COVID-19 status was unconfirmed.

Of the 28,189 STEMI cases reported, 25,150 (89.22%) were included for final analysis. The results show a 26% decrease in the total number of hospitalized STEMI cases during the outbreak across China and a 62% drop in hospitalized cases in Hubei province. Consistent with revised the revised STEMI protocol, the probability of primary PCI was significantly reduced nationwide (Odds Ratio [OR] = 0.76 [0.71, 0.81], p < 0.001), but the probability was lower in Hubei province (Interaction Term OR = 0.57 [0.37, 0.88], p < 0.001). During the outbreak, probability of thrombolysis increased (OR = 1.66 [1.50, 1.84], p < 0.001), particularly in Hubei province (Interaction Term OR = 4.78 [2.45, 9.33], p < 0.001).

Nationwide, the proportion of STEMI patients receiving timely reperfusion decreased from 65.13% before the outbreak to 60.10% during the outbreak. In Hubei province, the proportion went down from 59.44% to 51.56%. In addition, in-hospital mortality increased from 4.6% to 7.3% and in-hospital HF rose from 14.2% to 18.4% in Hubei province, while other provinces had smaller increases. The COVID-19 outbreak did not affect rates of in-hospital hemorrhage, either in Hubei province or nationwide.

The COVID-19 outbreak in China led to reductions in access to care for STEMI patients, delayed treatment, changes in reperfusion strategies, and increase of in-hospital mortality and HF, the researchers conclude. The findings "provide much needed empirical evidence for health care professionals searching for a balance between optimizing timely treatment for STEMI patients and protecting health care workers and vulnerable cardiovascular patients from the risk of nosocomial COVID-19 infection," they write.

The study add to the "growing evidence base that COVID-19 epicenters have had a decline in hospitalized STEMI cases, in conjunction with increases in time to reperfusion," Lauren S. Ranard, MD, et al., write in an accompanying Editorial Comment. Despite the revised protocol recommending thrombolysis as the preferred reperfusion strategy, the increase in in-hospital mortality and HF suggest that the "old adage of 'time is muscle' therefore remains true, pandemic or not," the authors conclude.

Clinical Topics: COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: COVID-19, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, Pandemics, Hospital Mortality, ST Elevation Myocardial Infarction, Cross Infection, Percutaneous Coronary Intervention, Time-to-Treatment

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