Impact of COVID-19 pandemic on door-toballoon time and mortality within a high reliability STEMI system of care

ABSTRACT

Background: The COVID-19 pandemic is associated with delayed revascularization and worse clinical outcomes for patients with ST-Elevation MI (STEMI). The purpose of this study was to evaluate whether a comprehensive STEMI protocol (CSP), which improved door-to-balloon times (D2BT) and mortality prior to the pandemic, mitigated the pandemic's negative effect on STEMI care and outcomes. Methods: We performed a prospective, single-center, registry-based study of 433 patients who received PCI for STEMI though an established CSP. We compared D2BT and in-hospital mortality of the period immediately prior to the pandemic (control period;1/1/19 -3/14/20, N=291) with the period from 3/15/20 to 12/31/20 (study period, N=142), in-line with the declaration of a state of emergency by the state of Ohio. Results: Between control and study period, patients were similar in regards to age (61.2 +/- 12.0 yrs vs. 61.7 +/-13.2 yrs), female sex (32.3% vs 30.3%), nonwhite race (30% vs 26%), smoking status, BMI (30.4 +/- 8.9 vs 29.9 +/- 6.3), and other comorbidities. There was no significant difference in % meeting D2BT goals for STEMI (<=90 minutes for ED and in-hospital, <=120 minutes for hospital transfer patients) during control and study periods (79.0% v 78.9%, p = 0.97). When stratified by STEMI presenting location, there was no significant difference between control and study period D2BT for patients presenting in primary ED (48 min [IQR 36-66] vs 60 min [IQR 42-73], p = 0.09), as hospital transfers (96 min [IQR 79-119] vs 95 min [IQR 80-112], p = 0.86), or from in-hospital locations (95 min [IQR 80-112] vs 95.8 min [IQR 52-120], p = 0.50). There was no significant difference in in-hospital mortality between the control and study periods (4.5% and 2.1%, p = 0.22). Conclusions: Despite the profound effect of pandemic on overall health care operations, there was little overall change in STEMI process and outcome metrics within a high reliability CSP.