Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience.

Journal: Revista Espanola De Cardiologia (English Ed.)

Published: May 29, 2020

Abstract

Objective: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak.

Methods: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19.

Results: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P<.001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P <.001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P=.017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization.

Conclusions: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Authors

Oriol Rodríguez Leor, Belén Cid Álvarez, Armando Pérez De Prado, Xavier Rossello, Soledad Ojeda, Ana Serrador, Ramón López Palop, Javier Martín Moreiras, José Rumoroso, Ángel Cequier, Borja Ibáñez, Ignacio Cruz González, Rafael Romaguera, Raúl Moreno, Rafael Ruíz Salmerón, Francisco Molano, Carlos Sánchez, Erika Muñoz García, Luís Íñigo, Juan Herrador, Antonio Gómez Menchero, Juan Caballero, Mérida Cárdenas, Livia Gheorghe, Jesús Oneto, Francisco Morales, Félix Valencia, José Ruíz, José Diarte, Pablo Avanzas, Juan Rondán, Vicente Peral, Lucía Pernasetti, Julio Hernández, Francisco Bosa, Pedro Luís Lorenzo, Francisco Jiménez, José M De La Hernández, Jesús Jiménez Mazuecos, Fernando Lozano, José Moreu, Enrique Novo, Javier Robles, Javier Moreiras, Felipe Fernández Vázquez, Ignacio Amat Santos, Joan Gómez Hospital, Joan García Picart, Bruno García Blanco, Ander Regueiro, Xavier Carrillo Suárez, Helena Tizón, Mohsen Mohandes, Juan Casanova, Víctor Agudelo Montañez, Juan Muñoz, Juan Franco, Roberto Del Castillo, Pablo Salinas, Jaime Elizaga, Fernando Sarnago, Santiago Jiménez Valero, Fernando Rivero, Juan Oteo, Eduardo Alegría Barrero, Ángel Sánchez Recalde, Valeriano Ruíz, Eduardo Pinar, Ana Planas, Bernabé Ledesma, Alberto Berenguer, Agustín Fernández Cisnal, Pablo Aguar, Francisco Pomar, Miguel Jerez, Francisco Torres, Ricardo García, Araceli Frutos, Juan Miguel Nodar, Koldobika García, Roberto Sáez, Alfonso Torres, Miren Tellería, Mario Sadaba, José Ramón Mínguez, Juan Carlos Merchán, Javier Portales, Ramiro Trillo, Guillermo Aldama, Saleta Fernández, Melisa Santás, María Pilar Pérez

Relevant Conditions

Severe Acute Respiratory Syndrome (SARS), COVID-19, Percutaneous Coronary Intervention (PCI), Heart Attack

Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience.

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