The impact of the COVID-19 pandemic on ST-segment elevation myocardial infarction treatment strategy and outcomes.

Abstract

Background: The most reliable care quality indicators for STEMI patients undergoing primary percutaneous coronary intervention (pPCI) include onset-to-door time (OTDT), time from admission to wire crossing and in-hospital mortality.

Aims: Our study aimed to evaluate the impact of the COVID-19 pandemic on these selected care quality indicators in pre-pandemic and pandemic groups of STEMI patients.

Methods: This single-centre, retrospective study, enrolled 480 STEMI patients, aged 63.59 ± 12.44 years treated with pPCI across two time frames: pre-pandemic (n = 331) and pandemic (n = 149). The evaluation criteria included OTDT, time from admission to PCI-mediated reperfusion, in-hospital mortality, and predictors of time delays.

Results: Our study revealed a significant increases in OTDT (median 3 h; IQR 1.5-12.0 vs. median 5 h; IQR 2.0-24.0, p = 0.011) and time from admission to wire crossing (median 92 min; IQR 65.0-187.0 vs. median 115.0; IQR 73.0-233.0, p = 0.025), in the COVID-19 pandemic group of STEMI patients, compared to the pre-pandemic subset. We also observed an increase in in-hospital mortality (7.85% vs. 14.09%, p = 0.033) and incidence of cardiogenic shock/cardiac arrest (16.62% vs. 26.85%, p = 0.009). Additionally, the proportion of patients with prolonged OTDT (24.45% vs. 35.71%, p = 0.019) and extended time from admission to PCI-mediated reperfusion (51.96% vs. 65.77%, p = 0.005) increased during the pandemic period.

Conclusions: The study's results indicated prolonged OTDT and admission-to-wire crossing times, increased in-hospital mortality, and the higher frequency of cardiogenic shock/cardiac arrest during the COVID-19 pandemic. These findings demonstrate the negative impact of the pandemic on treatment times and outcomes for patients diagnosed with STEMI.