Impact of COVID‐19 pandemic on ST‐elevation myocardial infarction in a non‐COVID‐19 epicenter

• Published in: Catheterization and cardiovascular interventions Vol. 97; no. 2; pp. 208 - 214
• Main Authors: Hammad, Tarek A., Parikh, Melanie, Tashtish, Nour, Lowry, Cynthia M., Gorbey, Diane, Forouzandeh, Farshad, Filby, Steven J., Wolf, William M., Costa, Marco A., Simon, Daniel I., Shishehbor, Mehdi H.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.02.2021; Wiley Subscription Services, Inc
• Subjects: Aged; Blood pressure; Calcium-binding protein; Communicable Disease Control; Coronary Artery Disease; coronavirus; COVID-19; COVID-19 - epidemiology; delayed presentation; door‐to‐balloon; Fear; Female; Heart attacks; Heart rate; Humans; Length of Stay; Male; Middle Aged; Myocardial infarction; Ohio; Original Studies; Pandemics; Public health; Retrospective Studies; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; Survival Rate; Time-to-Treatment; Treatment Outcome; Troponin; Ventricle; Ohio; door-to-balloon; length of stay; coronavirus; delayed presentation; troponin
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.28997

Objectives We sought to study the impact of COVID‐19 pandemic on the presentation delay, severity, patterns of care, and reasons for delay among patients with ST‐elevation myocardial infarction (STEMI) in a non‐hot‐spot region. Background COVID‐19 pandemic has significantly reduced the activations for STEMI in epicenters like Spain. Methods From January 1, 2020, to April 15, 2020, 143 STEMIs were identified across our integrated 18‐hospital system. Pre‐ and post‐COVID‐19 cohorts were based on March 23rd, 2020, whenstay‐at‐home orders were initiated in Ohio. We used presenting heart rate, blood pressure, troponin, new Q‐wave, and left ventricle ejection fraction (LVEF) to assess severity. Duration of intensive care unit stay, total length of stay, door‐to‐balloon (D2B) time, and radial versus femoral access were used to assess patterns of care. Results Post‐COVID‐19 presentation was associated with a lower admission LVEF (45 vs. 50%, p = .015), new Q‐wave, and higher initial troponin; however, these did not reach statistical significance. Among post‐COVID‐19 patients, those with >12‐hr delay in presentation 31(%) had a longer average D2B time (88 vs. 53 min, p = .033) and higher peak troponin (58 vs. 8.5 ng/ml, p = .03). Of these, 27% avoided the hospital due to fear of COVID‐19, 18% believed symptoms were COVID‐19 related, and 9% did not want to burden the hospital during the pandemic. Conclusions COVID‐19 has remarkably affected STEMI presentation and care. Patients' fear and confusion about symptoms are integral parts of this emerging public health crisis.