Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic : A nationwide study
OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1).
METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period.
RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001].
CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
Anatolian journal of cardiology - 24(2020), 5 vom: 31. Nov., Seite 334-342 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Erol, Mustafa Kemal [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 11.11.2020 Date Revised 28.05.2021 published: Print Citation Status MEDLINE |
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| doi: |
10.14744/AnatolJCardiol.2020.98607 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM316910236 |
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| 100 | 1 | |a Erol, Mustafa Kemal |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic |b A nationwide study |
| 264 | 1 | |c 2020 | |
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| 500 | |a Date Completed 11.11.2020 | ||
| 500 | |a Date Revised 28.05.2021 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1) | ||
| 520 | |a METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period | ||
| 520 | |a RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001] | ||
| 520 | |a CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 700 | 1 | |a Kayıkçıoğlu, Meral |e verfasserin |4 aut | |
| 700 | 1 | |a Kılıçkap, Mustafa |e verfasserin |4 aut | |
| 700 | 1 | |a Güler, Arda |e verfasserin |4 aut | |
| 700 | 1 | |a Yıldırım, Abdullah |e verfasserin |4 aut | |
| 700 | 1 | |a Kahraman, Fatih |e verfasserin |4 aut | |
| 700 | 1 | |a Can, Veysi |e verfasserin |4 aut | |
| 700 | 1 | |a Inci, Sinan |e verfasserin |4 aut | |
| 700 | 1 | |a Baysal, Sadettin Selçuk |e verfasserin |4 aut | |
| 700 | 1 | |a Er, Okan |e verfasserin |4 aut | |
| 700 | 1 | |a Zeybey, Utku |e verfasserin |4 aut | |
| 700 | 1 | |a Kafkas, Çağrı |e verfasserin |4 aut | |
| 700 | 1 | |a Yayla, Çağrı |e verfasserin |4 aut | |
| 700 | 1 | |a Arin, Can Baba |e verfasserin |4 aut | |
| 700 | 1 | |a Aktaş, Ibrahim |e verfasserin |4 aut | |
| 700 | 1 | |a Yalçın, Ahmet Arif |e verfasserin |4 aut | |
| 700 | 1 | |a Genç, Ömer |e verfasserin |4 aut | |
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