Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
J Cardiovasc Pharmacol. 2020 Nov;76(5):540-548. doi: 10.1097/FJC.0000000000000909.
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) during the COVID-19 pandemic. We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (during the COVID-19 pandemic), and from January 1, 2019, to December 31, 2019 (before the COVID-19 pandemic), respectively. Fifty-three AMI patients (31 STEMI, 22 NSTEMI) during the COVID-19 pandemic were matched to 53 AMI patients before the pandemic. Baseline characteristics were comparable between the matched patients. STEMI patients during the COVID-19 pandemic had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those before the pandemic. Less coronary angiography and stenting were performed in AMI patients during the COVID-19 pandemic than before the pandemic. There were no statistically significant differences in the clinical outcomes between the matched patients. However, STEMI patients during the COVID-19 pandemic had a 4-fold (12.9% vs. 3.2%) increase in all-cause mortality rate compared with those before the pandemic. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. This study demonstrates that the COVID-19 pandemic results in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. The mortality rate of STEMI patients exhibits an increasing trend during the pandemic of COVID-19.
2019 年冠状病毒病（COVID-19）的爆发迅速在全球范围内蔓延。本研究旨在分享我们在 COVID-19 大流行期间对急性心肌梗死（AMI）院内管理和结局的经验。我们回顾性分析了连续的 AMI 患者，包括 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）患者，分别来自 2020 年 2 月 1 日至 4 月 15 日（COVID-19 大流行期间）和 2019 年 1 月 1 日至 2019 年 12 月 31 日（COVID-19 大流行前）。COVID-19 大流行期间的 53 例 AMI 患者（31 例 STEMI，22 例 NSTEMI）与大流行前的 53 例 AMI 患者相匹配。匹配患者的基线特征无差异。COVID-19 大流行期间的 STEMI 患者延迟时间更长，行直接或补救性经皮冠状动脉介入治疗（PCI）更少，行急诊溶栓治疗更多。COVID-19 大流行期间 AMI 患者行冠状动脉造影和支架置入术更少。匹配患者的临床结局无统计学差异。然而，COVID-19 大流行期间的 STEMI 患者的全因死亡率较大流行前增加了 4 倍（12.9%比 3.2%）。AMI 合并 COVID-19 感染的患者死亡率高于单纯 AMI 患者。本研究表明，COVID-19 大流行导致 STEMI 患者再灌注延迟明显，并对 AMI 患者的治疗方案选择产生显著影响。STEMI 患者的死亡率在 COVID-19 大流行期间呈上升趋势。
