Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

• Published in: Journal of the American College of Cardiology 2020-09, Vol.76 (11), p.1318-1324
• Main Authors: Xiang, Dingcheng, Xiang, Xin, Zhang, Wei, Yi, Shaodong, Zhang, Jinxia, Gu, Xiaolong, Xu, Yawei, Huang, Kai, Su, Xi, Yu, Bo, Wang, Yan, Fang, Weiyi, Huo, Yong, Ge, Junbo
• Format: Article
• Language: English
• Subjects: Betacoronavirus; chest pain center; China - epidemiology; Coronary Angiography - methods; Coronary Angiography - statistics & numerical data; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; COVID-19; Female; Heart Failure - epidemiology; Heart Failure - etiology; Hospital Mortality; Hospitalization; Humans; Infection Control - methods; Infection Control - organization & administration; Male; Middle Aged; Organizational Innovation; Original Investigation; Outcome and Process Assessment, Health Care; Pandemics - prevention & control; Patient Care - methods; Patient Care - trends; Percutaneous Coronary Intervention - methods; Percutaneous Coronary Intervention - statistics & numerical data; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; primary percutaneous coronary intervention; SARS-CoV-2; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - therapy; ST-segment elevation myocardial infarction; thrombolysis; Thrombolytic Therapy - methods; Thrombolytic Therapy - statistics & numerical data
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2020.06.039

ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients. This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol on the treatment and prognosis of STEMI patients in China. Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients. The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable. There were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China. [Display omitted]