J Korean Med Sci.  2022 May;37(21):e167. 10.3346/jkms.2022.37.e167.

Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction

• Choi H
• Lee JH
• Park HK
• Lee E
• Kim MS
• Kim HJ
• Park BE
• Kim HN
• Kim N
• Jang SY
• Bae MH
• Yang DH
• Park HS
• Cho Y

• KMID: 2530112
• DOI: http://doi.org/10.3346/jkms.2022.37.e167

Abstract

Background
It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior.
Methods
A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and prepandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death.
Results
There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs.2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic.
Conclusion
During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.

Keyword

Coronavirus; SARS-CoV-2; COVID-19; Time Delay; Cardiac Arrest; Acute Myocardial Infarction; Prognosis

Figure

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  Fig. 1 Study flow diagram.AMI = acute myocardial infarction, FEB = February, MAR = March, APR = April, CAG = coronary angiography, SCMP = stress induced cardiomyopathy, STEMI = ST-segment elevation myocardial infarction.

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  Fig. 2 Frequency of hospital admission of overall AMI, STEMI, and non-STEMI from February to April in 2017, 2018, 2019, and 2020.AMI = acute myocardial infarction, STEMI = ST-segment elevation myocardial infarction.

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  Fig. 3 Comparison of patient delay in (A) ST-segment elevation myocardial infarction and (B) non-ST-segment elevation myocardial infarction between pre-pandemic and pandemic era.ER = emergency room.

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  Fig. 4 The incidence of in-hospital death and cardiac arrest in (A) STEMI and (B) non-STEMI between pre-pandemic and pandemic era.STEMI = ST-segment elevation myocardial infarction.

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