Keele Cardiovascular Research Group Institute for Prognosis Research School of Primary Care Keele University Newcastle UK.
Department of Cardiology Royal Stoke Hospital Stoke-on-Trent UK.
J Am Heart Assoc. 2020 Nov 17;9(22):e018379. doi: 10.1161/JAHA.120.018379. Epub 2020 Oct 7.
Background Studies have reported significant reduction in acute myocardial infarction-related hospitalizations during the coronavirus disease 2019 (COVID-19) pandemic. However, whether these trends are associated with increased incidence of out-of-hospital cardiac arrest (OHCA) in this population is unknown. Methods and Results Acute myocardial infarction hospitalizations with OHCA during the COVID-19 period (February 1-May 14, 2020) from the Myocardial Ischaemia National Audit Project and British Cardiovascular Intervention Society data sets were analyzed. Temporal trends were assessed using Poisson models with equivalent pre-COVID-19 period (February 1-May 14, 2019) as reference. Acute myocardial infarction hospitalizations during COVID-19 period were reduced by >50% (n=20 310 versus n=9325). OHCA was more prevalent during the COVID-19 period compared with the pre-COVID-19 period (5.6% versus 3.6%), with a 56% increase in the incidence of OHCA (incidence rate ratio, 1.56; 95% CI, 1.39-1.74). Patients experiencing OHCA during COVID-19 period were likely to be older, likely to be women, likely to be of Asian ethnicity, and more likely to present with ST-segment-elevation myocardial infarction. The overall rates of invasive coronary angiography (58.4% versus 71.6%; <0.001) were significantly lower among the OHCA group during COVID-19 period with increased time to reperfusion (mean, 2.1 versus 1.1 hours; =0.05) in those with ST-segment-elevation myocardial infarction. The adjusted in-hospital mortality probability increased from 27.7% in February 2020 to 35.8% in May 2020 in the COVID-19 group (<.001). Conclusions In this national cohort of hospitalized patients with acute myocardial infarction, we observed a significant increase in incidence of OHCA during COVID-19 period paralleled with reduced access to guideline-recommended care and increased in-hospital mortality.
背景 研究报告称，在 2019 冠状病毒病（COVID-19）大流行期间，与急性心肌梗死相关的住院治疗显著减少。然而，目前尚不清楚这些趋势是否与该人群中心脏骤停（OHCA）的发生率增加有关。
方法和结果 从心肌血运重建项目和英国心血管介入学会的数据集分析了 COVID-19 期间（2020 年 2 月 1 日至 5 月 14 日）的急性心肌梗死住院患者合并 OHCA 的情况。使用泊松模型评估时间趋势，以 COVID-19 前时期（2019 年 2 月 1 日至 5 月 14 日）为参照。与 COVID-19 前时期（n=9325）相比，COVID-19 期间的急性心肌梗死住院患者减少了>50%（n=20310）。与 COVID-19 前时期（3.6%）相比，COVID-19 期间 OHCA 的发生率更高（5.6%），OHCA 的发病率增加了 56%（发病率比，1.56；95%CI，1.39-1.74）。在 COVID-19 期间发生 OHCA 的患者年龄更大、更可能为女性、更可能为亚洲人种，并且更可能表现为 ST 段抬高型心肌梗死。COVID-19 期间 OHCA 患者的经皮冠状动脉介入治疗（58.4% 对 71.6%；<0.001）的总体率显著较低，ST 段抬高型心肌梗死患者的再灌注时间（平均 2.1 小时对 1.1 小时；=0.05）也有所增加。COVID-19 组的住院死亡率从 2020 年 2 月的 27.7%增加到 5 月的 35.8%（<.001）。
结论 在这项针对急性心肌梗死住院患者的全国性队列研究中，我们观察到 COVID-19 期间 OHCA 的发病率显著增加，同时接受指南推荐的治疗的机会减少，住院死亡率增加。
