Management of myocardial infarction in Slovakia in the period of the 2020 COVID-19 pandemic. Current analysis of the SLOVAKS registry

ABSTRACT

In 2020, the last periodic snapshot of the SLOVAKS registry, dedicated to the management of patients with ACS, took place in Slovakia. Results: 1450 patients were analyzed, with the proportion of STEMI representing 41.5%. Primary reperfusion therapy was performed in 89.1% of patients (pPCI 88.7%, fibrinolysis 0.4%). The median of total ischemic interval was 260 min, which was an insignificant prolongation compared to year 2015 (230.5 min) (p = 0.277). At the time of the COVID19 pandemic, the expected significant increase in the total ischemic interval was probably offset by the widespread use of the telemedicine communication platform STEMI, which led to a significant increase in the ability of EMS crews to provide STEMI ECG diagnostics in the field (38.8 vs. 61.4%), and increase primary transports to pPCI centers (48.45 vs. 62.2%). Of all pPCI cases, up to 37.4% were performed outside the recommended time limit (within 120 minutes of the ECG) and 63.5% outside the optimal time limit (within 90 minutes of the ECG). Patient hesitation (median of symptoms-ECG interval 150 min) and patient transport had a decisive share in unnecessary time losses, as up to 37.8% of STEMIs were transported to the primary PCI by secondary transport. STEMI hospitalization lethality was 4.5%. Conclusion: At the time of the COVID19 pandemic, the Slovak health care system maintained a high quality of management for patients with acute STEMI and there was no significant deterioration in the monitored quality parameters. Despite several positive trends (high concentration of emergency medical crews, unlimited availability of modern drugs, availability of invasive management 24/7, increased ability of emergency medical crews to provide ECG diagnostics of STEMI in the field) several deficiencies can be identified in the health care system. Above all, these are inappropriate time losses caused by patients, but also by the health care system due to unnecessary so-called secondary transports. A significant part of the patients met the indication for prehospital administration of fibrinolytics and so-called pharmacoinvasive procedure. The disappearance of this procedure from medical practice is medically unjustifiable. Fig. 8, Tab. 7, Ref. 12, on-line full text (Free, PDF) www.cardiologyletters.sk.