Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota.
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2021 Aug 1;98(2):217-222. doi: 10.1002/ccd.29154. Epub 2020 Aug 7.
To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care.
We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data.
Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC.
Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p < .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p < .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05).
The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI.
评估 COVID-19 大流行缓解措施对 ST 段抬高型心肌梗死（STEMI）治疗的影响。
我们之前报道过，在 COVID-19 大流行缓解措施的早期阶段，心脏导管插入术激活数量下降了 38%。本研究使用来自美国不同地区的更大样本 STEMI 计划扩展了我们的早期观察结果，其中包括更多的当代数据。
从美国的 18 家医院或医疗保健系统收集 2019 年 1 月至 2020 年 4 月的数据，包括 STEMI 的激活数量、导致血管造影和经皮冠状动脉介入治疗（PPCI）的激活数量以及平均门到球囊（D2B）时间。定义了两个时期，2019 年 1 月至 2 月和 2020 年 3 月至 4 月，分别代表大流行缓解措施之前（BC）和之后（AC）。使用广义估计方程方法估计 AC 时期与 BC 时期相比，因变量的变化。
与 BC 相比，AC 时期 STEMI 的激活数量明显减少（29%，95%CI：18-38，p<0.001），导致血管造影的激活数量减少（34%，95%CI：12-50，p=0.005）和导致 PPCI 的激活数量减少（20%，95%CI：11-27，p<0.001）。STEMI 激活数量的下降导致血管造影和 PPCI 数量的减少。与 BC 相比，AC 时期的 D2B 时间平均增加了 20%，95%CI（-0.2 至 44，p=0.05）。
COVID-19 大流行对 STEMI 治疗的许多方面都产生了不利影响，包括及时获得心脏导管插入术实验室进行 PPCI。
