Evidence-Based Medicine
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2021; 13(4): 76-81
Published online Apr 26, 2021. doi: 10.4330/wjc.v13.i4.76
Challenges in managing ST elevation myocardial infarction during the COVID-19 pandemic
Megan Smith, Aniruddha Singh, Douglas McElroy, Shilpi Mittal, Richard Pham
Megan Smith, Aniruddha Singh, Richard Pham, Department ofCardiology, University of Kentucky College of Medicine, Bowling Green, KY 42101, United States
Aniruddha Singh, Department of Cardiology, Western Kentucky Heart and Lung Research Foundation, Bowling Green, KY 42101, United States
Aniruddha Singh, Department of Cardiology, The Medical Center, Bowling Green, KY 42101, United States
Douglas McElroy, Department of Biology, Western Kentucky University, Bowling Green, KY 42101, United States
Shilpi Mittal, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
Author contributions: Singh A and Smith M contributed equally to this work; Singh A, Smith M, Mittal S, McElroy D and Pham R designed the study and contributed to the manuscript; Smith M and Pham R performed data extraction; McElroy D performed statistics and wrote the methods and results section; all authors have read the original and revised copy of the manuscript and approve the final version.
Conflict-of-interest statement: All the authors of this study report no potential conflict of interest related to any aspect of the study.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Aniruddha Singh, FACC, MBBS, Assistant Professor, Department of Cardiology, University of Kentucky College of Medicine, 399 US 31W Bypass, Bowling Green, KY 42101, United States. aniruddha.singh@uky.edu
Received: October 20, 2020
Peer-review started: October 20, 2020
First decision: December 24, 2020
Revised: January 4, 2021
Accepted: March 7, 2021
Article in press: March 7, 2021
Published online: April 26, 2021
Processing time: 183 Days and 9 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) may contribute to delayed presentations of acute myocardial infarction. Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes. Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19. Also, standardized personal protective equipment precautions are established for all members of the team, regardless of pending COVID-19 testing which might further add to delays.

AIM

To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction (STEMI) during the COVID-19 pandemic to same time cohort from 2019.

METHODS

All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019. STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded. Primary outcome was major adverse cardiac events (MACE) in-hospital and up to 14 d after STEMI, including death, myocardial infarction, cardiac arrest, or stroke. Significant differences among groups for continuous variables were tested through ANOVA, using SYSTAT, version 13. Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT. Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc (MedCalc Software, Ostend, Belgium).

RESULTS

There was a significantly longer time interval from symptom onset to first medical contact (FMC) in the COVID-19 group (P < 0.02). Time to first electrocardiogram, door-to-balloon time, and FMC to balloon time were not significantly affected. The right coronary artery was the most common culprit for STEMI in both the cohorts. Over 60% of patients had one or more obstructive (> 50%) lesion(s) remote from the culprit site. In-hospital and 14 d MACE were more prevalent in the COVID-19 group (P < 0.01 and P < 0.001).

CONCLUSION

This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.

Keywords: COVID-19; ST elevation myocardial infarction; First medical contact to balloon; Major adverse cardiac events; Cardiac arrest; Death

Core Tip: The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of healthcare and has created multiple challenges in treatment of time sensitive conditions like ST elevation myocardial infarction (STEMI). We aimed to assess the behavior of presentation and outcomes of all the STEMI admissions at our facility between March 16, 2020 and August 31, 2020. We found a significantly delay from symptom onset to first medical contact in the COVID-19 group which likely resulted in significantly higher in-hospital major adverse cardiac events (MACE) and MACE at 14 d in this cohort.