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Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study.
Clifford, Cole R; Le May, Michel; Chow, Alyssa; Boudreau, Rene; Fu, Angel Y N; Barry, Quinton; Chong, Aun Yeong; So, Derek Y F.
  • Clifford CR; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Le May M; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
  • Chow A; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Boudreau R; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Fu AYN; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Barry Q; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Chong AY; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • So DYF; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
CJC Open ; 2020 Dec 15.
Article in English | MEDLINE | ID: covidwho-1056468
ABSTRACT

BACKGROUND:

Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have impacted STEMI management. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system.

METHODS:

494 patients with STEMI were grouped into pre-lockdown, lockdown and re-opening cohorts. Clinical, temporal and outcome data were collected and compared between groups for both urban and rural patients, receiving primary percutaneous coronary intervention (PCI) and pharmacoinvasive revascularization, respectively. Data was compared to a 10-year historical comparator.

RESULTS:

During pre-lockdown there was 238 cases versus 193 in lockdown; a 19.0% reduction in volume. When lockdown was compared to the median caseload from a 10-year historical cohort, a 19.8% reduction was observed. For patients treated with primary PCI during lockdown, median symptom-to-balloon time increased by 44-minutes [217 (IQR 157-387) vs. 261 (160-659) minutes; p=0.03]; driven by an increase in median symptom-to-door time of 41-minutes [136 (IQR 80-267) vs. 177 (IQR 90-569) minutes; p<0.01]. Only patients transferred from non-PCI facilities demonstrated an increase in door-to-reperfusion time [116 (IQR 93-150) vs. 139 (IQR 100-199) minutes; p<0.01]. More patients had left ventricular dysfunction during the lockdown [35% vs. 44%; p=0.04], but there was no difference in mortality.

CONCLUSION:

During the COVID-19 lockdown, fewer patients presented with STEMI. Time-to-reperfusion was significantly prolonged and appeared driven predominantly by patient-level and transfer delays. Public education and systems-level changes will be integral to STEMI care during the second wave of COVID-19.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2020 Document Type: Article Affiliation country: J.cjco.2020.12.009

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2020 Document Type: Article Affiliation country: J.cjco.2020.12.009