One-year outcomes of patients with ST-segment elevation myocardial infarction during the COVID-19 pandemic.

The pandemic has led to adverse short-term outcomes for patients with ST-segment elevation myocardial infarction (STEMI). It is unknown if this translates to poorer long-term outcomes. In Singapore, the escalation of the outbreak response on February 7, 2020 demanded adaptation of STEMI care to stringent infection control measures. A total of 321 patients presenting with STEMI and undergoing primary percutaneous coronary intervention at a tertiary hospital were enrolled and followed up over 1-year. They were allocated into three groups based on admission date-(1) Before outbreak response (BOR): December 1, 2019-February 6, 2020, (2) During outbreak response (DOR): February 7-March 31, 2020, and (3) control group: November 1-December 31, 2018. The incidence of cardiac-related mortality, cardiac-related readmissions, and recurrent coronary events were examined. Although in-hospital outcomes were worse in BOR and DOR groups compared to the control group, there were no differences in the 1-year cardiac-related mortality (BOR 8.7%, DOR 7.1%, control 4.8%, p = 0.563), cardiac-related readmissions (BOR 15.1%, DOR 11.6%, control 12.0%, p = 0.693), and recurrent coronary events (BOR 3.2%, DOR 1.8%, control 1.2%, p = 0.596). There were higher rates of additional PCI during the index admission in DOR, compared to BOR and control groups (p = 0.027). While patients admitted for STEMI during the pandemic may have poorer in-hospital outcomes, their long-term outcomes remain comparable to the pre-pandemic era.

Impact of the COVID-19 Pandemic on Door-to-Balloon Time for Primary Percutaneous Coronary Intervention　- Results From the Singapore Western STEMI Network.

BACKGROUND: Little is known about the effect of the coronavirus disease 2019 (COVID-19) pandemic and the outbreak response measures on door-to-balloon time (D2B). This study examined both D2B and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).Methods and Results:This was a retrospective study of 303 STEMI patients who presented directly or were transferred to a tertiary hospital in Singapore for PPCI from October 2019 to March 2020. We compared the clinical outcomes of patients admitted before (BOR) and during (DOR) the COVID-19 outbreak response. The study outcomes were in-hospital death, D2B, cardiogenic shock and 30-day readmission. For direct presentations, fewer patients in the DOR group achieved D2B time <90 min compared with the BOR group (71.4% vs. 80.9%, P=0.042). This was more apparent after exclusion of non-system delay cases (DOR 81.6% vs. BOR 95.9%, P=0.006). Prevalence of both out-of-hospital cardiac arrest (9.5% vs. 1.9%, P=0.003) and acute mitral regurgitation (31.6% vs. 17.5%, P=0.006) was higher in the DOR group. Mortality was similar between groups. Multivariable regression showed that longer D2B time was an independent predictor of death (odds ratio 1.005, 95% confidence interval 1.000-1.011, P=0.029). CONCLUSIONS: The COVID-19 pandemic and the outbreak response have had an adverse effect on PPCI service efficiency. The study reinforces the need to focus efforts on shortening D2B time, while maintaining infection control measures.

Middle ground approach to paradox: Within- and between-culture examination of the creative benefits of paradoxical frames.

Thriving in increasingly complex and ambiguous environments requires creativity and the capability to reconcile conflicting demands. Recent evidence with Western samples has suggested that paradoxical frames, or mental templates that encourage individuals to recognize and embrace contradictions, could produce creative benefits. We extended the timely, but understudied, topic by studying the nuances of for whom and why creative advantages of paradoxical frames emerge. We suggest that people endorsing a middle ground approach are less likely to scrutinize conflict and reconcile with integrative solutions, thus receiving less creative benefits of paradoxical frames. Five studies that examined individual and cultural differences in middle ground endorsement support our theory. Study 1 found that paradoxical frames increased creativity, but failed to replicate that experienced conflict mediated the relationship in a Taiwanese sample. In both within- and between-culture analysis, we showed that the creative advantages of thinking paradoxically and experiencing conflict emerged among individuals who endorse lower (vs. higher) levels of middle ground (Study 2) and among Israelis whose culture predominantly endorses middle ground strategy less, but not among Singaporeans whose culture predominantly endorses middle ground more (Study 3). Study 4 further demonstrated the causal role of middle ground in the paradox-conflict-creativity link. To answer "why," Study 5 situationally induced integrative complex thinking that sets distinctions and forms syntheses among contradictory elements, and found that low endorsers of middle ground performed more creatively when they engaged integrative complex thinking to cope with paradoxes. This program of studies offers important insights on harnessing paradoxical experiences to catalyze creativity. (PsycINFO Database Record