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

• Published in: Journal of Korean medical science 2022, 37(21), , pp.1-12
• Main Authors: Choi, Hyohun, Lee, Jang Hoon, Park, Hyuk Kyoon, Lee, Eunkyu, Kim, Myeong Seop, Kim, Hyeon Jeong, Park, Bo Eun, Kim, Hong Nyun, Kim, Namkyun, Jang, Se Yong, Bae, Myung Hwan, Yang, Dong Heon, Park, Hun Sik, Cho, Yongkeun
• Format: Article
• Language: English
• Subjects: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; COVID-19; Heart Arrest; Hospital Mortality; Humans; Myocardial Infarction; Original; Pandemics; ST Elevation Myocardial Infarction - epidemiology; 의학일반
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2022.37.e167

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. 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 pre-pandemic 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. 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, = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, = 0.397) and in-hospital mortality (15.6% vs. 10.4%, = 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, = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, = 0.017) and in-hospital mortality (0.3% vs. 2.3%, = 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%, = 0.021) and non-STEMI (67.8% vs. 57.0%, = 0.061) during the pandemic. 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.