The Impact Of COVID-19 Pandemic On Management And Prognosis Of ST-segment Elevation Myocardial Infarction

AimsThe outbreak of Coronavirus Disease 2019(COVID-19)has directly or indirectly led to an increase in mortality among patients with ST-segment elevation myocardial infarction(STEMI).Previous studies have found that the COVID-19 pandemic has had a significant impact on in-hospital management and prognosis of STEMI patients.However,it is unclear whether these adverse effects persist in the post-outbreak of the COVID-19.This study aims to use data from the Chinese Cardiovascular Association Chest Pain Center database(a non-public database)to investigate the impact of the COVID-19 epidemic on in-hospital management and prognosis of STEMI patients in the post-outbreak period,providing a reference for the in-hospital management and treatment of Chinese STEMI patients during post-outbreak.MethodsThis study analyzed the impact of different stages of the COVID-19 epidemic(including pre-outbreak,outbreak,and post-outbreak periods)on in-hospital management and prognosis of STEMI patients using data from the Chinese Cardiovascular Association Chest Pain Center database from October 23,2019,to July 22,2020,with a special focus on the lingering effects of the post-outbreak period.The data included demographic information,medical diagnoses,relevant time points during treatment,and outcome information of STEMI patients.Given the characteristics of the epidemic,the geographic regions were divided into Hubei Province and non-Hubei areas for exploratory analysis.The primary study outcome was in-hospital mortality,while secondary outcomes included the following:① patient delay(time interval between onset of chest pain symptoms and first medical contact),② system delay(time interval between first medical contact and the end or beginning of primary percutaneous coronary intervention(PPCI)or thrombolysis treatment)and timely reperfusion,and ③ whether PPCI or thrombolysis treatment was performed.Multivariate logistic regression models were used to analyze the effects of different outbreak stages on various outcomes.Furthermore,the relationship between the COVID-19 cumulative incidence rate in different cities and changes in in-hospital management and prognosis of STEMI patients was further explored.ResultsThe analysis of data from 141,375 patients showed that compared to the pre-outbreak period,the proportion of STEMI patients admitted during the outbreak period decreased by 4.8%.However,the number of patients admitted during the post-outbreak period exceeded pre-outbreak levels.Multivariate logistic regression analysis showed that compared to the pre-outbreak period,the in-hospital mortality risk of STEMI patients in both Hubei and non-Hubei provinces during the outbreak period increased by 62%and 19%,respectively(Hubei province:OR:1.62,95%CI:1.09-2.41;non-Hubei province:OR:1.19,95%CI:1.10-1.29).However,during the post-outbreak period,the mortality risk had returned to pre-outbreak levels.In Hubei province,compared to the pre-outbreak period,the proportion of patients receiving PPCI treatment during the outbreak period decreased significantly(OR:0.23,95%CI:0.18-0.30),and had partially recovered during the postoutbreak period(OR:0.73,95%CI:0.55-0.96);the proportion of patients receiving timely reperfusion also decreased during the outbreak period(OR:0.43,95%CI:0.35-0.53),and was still affected by the epidemic during the post-outbreak period(OR:0.74,95%CI:0.62-0.88).In non-Hubei provinces,all types of outcomes during the post-outbreak period had returned to pre-outbreak levels.ConclusionDuring the post-outbreak of the COVID-19,the in-hospital mortality of STEMI patients has almost returned to the level in the pre-outbreak period.However,in Hubei province,the negative impact of the COVID-19 during the post-outbreak perios on the PPCI treatment and timely reperfusion for STEMI patients still exists.This suggests that medical institutions and public health departments should strive to establish more chest pain centers capable of performing PPCI and develop better strategies for STEMI patient in-hospital treatment to improve reperfusion therapy efficiency and avoid adverse prognostic effects on patients.