RESUMEN
OBJECTIVE: To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care. BACKGROUND: We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data. METHODS: Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC. RESULTS: Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p < .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p < .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05). CONCLUSIONS: The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI.
Asunto(s)
Angioplastia Coronaria con Balón/estadística & datos numéricos , COVID-19/epidemiología , Intervención Coronaria Percutánea/estadística & datos numéricos , Sistema de Registros , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/epidemiología , Comorbilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Pandemias , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/cirugía , Factores de Tiempo , Estados Unidos/epidemiologíaAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Personal de Salud , Exposición Profesional/prevención & control , Intervención Coronaria Percutánea , Neumonía Viral/terapia , Infarto del Miocardio con Elevación del ST/terapia , COVID-19 , Infecciones por Coronavirus/epidemiología , Fibrinolíticos/uso terapéutico , Personal de Salud/normas , Humanos , Exposición Profesional/efectos adversos , Pandemias , Intervención Coronaria Percutánea/efectos adversos , Neumonía Viral/epidemiología , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/epidemiologíaRESUMEN
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly infectious, carries significant morbidity and mortality, and has rapidly resulted in strained health care system and hospital resources. In addition to patient-related care concerns in infected individuals, focus must also relate to diminishing community spread, protection of staff, case selection, and concentration of resources. The current document based on available data and consensus opinion addresses appropriate catheterization laboratory preparedness for treating these patients, including procedure-room readiness to minimize external contamination, safe donning and doffing of personal protective equipment (PPE) to eliminate risk to staff, and staffing algorithms to minimize exposure and maximize team availability. Case selection and management of both emergent and urgent procedures are discussed in detail, including procedures that may be safely deferred or performed bedside.