Impact of COVID-19 Pandemic on Primary PCI for STEMI

Quick Takes

  • COVID-19 has had a significant impact on STEMI care and outcomes.
  • There was an approximate 20% reduction in STEMI patients during the pandemic with increased in-hospital mortality compared to 2019.
  • Efforts to reduce delay in seeking appropriate care as well as time to reperfusion will need to be addressed as the pandemic continues.

Study Questions:

What has been the impact of the coronavirus disease (COVID-19) pandemic on clinical outcomes among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI)?

Methods:

This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPCI in March/April 2019 and 2020. The main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality.

Results:

A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. Compared to 2019, during the pandemic in 2020, there was a significant reduction in PPCI (incidence rate ratio, 0.811; 95% confidence interval, 0.78-0.84; p < 0.0001). A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic.

Conclusions:

The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic.

Perspective:

This is the largest retrospective analysis evaluating the global trend of reduced overall STEMI volume and increased STEMI mortality during the COVID-19 pandemic. Data from this registry of 77 centers in 18 European countries showed a nearly 20% reduction in STEMI patients undergoing PPCI compared to 2019. This most likely was secondary to stay-at-home orders and public health messaging to minimize emergency room visits. In addition, delayed presentations, reperfusion times, and COVID-19 infection contributed to higher in-hospital mortality. Findings underscore the importance of balancing the need for appropriate containment measures during the pandemic, with educating patients about seeking necessary care for symptoms of acute myocardial infarction.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and ACS, Interventions and Vascular Medicine, Hypertension, Chronic Angina

Keywords: Acute Coronary Syndrome, Coronavirus, COVID-19, Emergency Service, Hospital, Hospital Mortality, Hypertension, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Reperfusion, ST Elevation Myocardial Infarction, Time-to-Treatment


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