Aldujeli Ali, Hamadeh Anas, Briedis Kasparas, Tecson Kristen M, Rutland Joshua, Krivickas Zilvinas, Stiklioraitis Simas, Briede Kamilija, Aldujeili Montazar, Unikas Ramunas, Zaliaduonyte Diana, Zaliunas Remigijus, Vallabhan Ravi C, McCullough Peter A
Lithuanian University of Health Sciences, Kaunas, Lithuania.
Baylor University Medical Center, Dallas, TX, USA.
Cardiol Res. 2020 Dec;11(6):386-391. doi: 10.14740/cr1175. Epub 2020 Nov 2.
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had a major impact on the behavior of patients, as well as on the delivery of healthcare services. With older and more medically vulnerable people tending to stay at home to avoid contracting the virus, it is unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if delays in presentation and healthcare service delivery for AMI exist during the COVID-19 pandemic compared to the same period a year prior.
In this single-center, retrospective study, we evaluated patients admitted with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during early months of the COVID-19 pandemic (March 11, 2020 to April 20, 2020) compared to patients admitted with same diagnosis during the same period a year prior.
There were 30 and 62 patients who presented with NSTEMI in the pandemic and pre-pandemic eras, respectively. The median pain-to-door time was significantly larger during the pandemic compared to pre-pandemic era (1,885 (880, 5,732) vs. 606 (388, 944) min, P < 0.0001). There was a significant delay in door-to-reperfusion time during the pandemic with a median time of 332 (182, 581) vs. 194 (92, 329) min (P = 0.0371). There were 24 (80%) and 25 (42%) patients who presented after 12 h of pain onset in pandemic and pre-pandemic eras, respectively (P = 0.0006). There were 47 and 60 patients who presented with STEMI during the pandemic timeframe of study and pre-pandemic timeframe, respectively. The median pain-to-door time during the pandemic was significantly larger than that of the pre-pandemic (620 (255, 1,500) vs. 349 (146, 659) min, P = 0.0141). There were 22 (47%) and 14 (24%) patients who presented after 12 h of pain onset in the pandemic and pre-pandemic eras, respectively (P = 0.0127). There was not a significant delay in door-to-reperfusion time (P = 0.9833). There were no differences in in-hospital death, stroke, or length of hospitalization between early and late presenters, as well as between pandemic and pre-pandemic eras.
In conclusion, this study found that patients waited significantly longer during the pandemic to seek medical treatment for AMI compared to before the pandemic, and that pandemic-specific protocols may delay revascularization for NSTEMI patients. These findings resulted in more than a threefold increase from the onset of symptoms to revascularization increasing the risks for future complications such as left ventricular dysfunction and cardiovascular death. Efforts should be made to increase patients' awareness regarding consequences of delayed presentation, and to find a balance between hospital evaluation strategies and goals of minimizing total ischemic time.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）大流行，对患者的行为以及医疗服务的提供产生了重大影响。由于年龄较大且医疗状况更脆弱的人群倾向于待在家中以避免感染病毒，急性心肌梗死（AMI）患者的行为发生了怎样的变化尚不清楚。本研究的目的是确定与一年前的同期相比，在COVID-19大流行期间，AMI患者就诊及医疗服务提供是否存在延迟。
在这项单中心回顾性研究中，我们评估了在COVID-19大流行早期（2020年3月11日至2020年4月20日）因ST段抬高型心肌梗死（STEMI）或非ST段抬高型心肌梗死（NSTEMI）入院的患者，并与一年前同期因相同诊断入院的患者进行比较。
在大流行期间和大流行前时期，分别有30例和62例患者表现为NSTEMI。与大流行前时期相比，大流行期间从疼痛发作到入院的中位时间显著更长（1,885（880, 5,732）分钟对606（388, 944）分钟，P < 0.0001）。大流行期间从入院到再灌注的时间存在显著延迟，中位时间为332（182, 581）分钟对194（92, 329）分钟（P = 0.0371）。在大流行期间和大流行前时期，分别有24例（80%）和25例（42%）患者在疼痛发作12小时后就诊（P = 0.0006）。在大流行研究时间段和大流行前时间段，分别有47例和60例患者表现为STEMI。大流行期间从疼痛发作到入院的中位时间显著长于大流行前（620（255, 1,500）分钟对349（146, 659）分钟，P = 0.0141）。在大流行期间和大流行前时期分别有22例（47%）和14例（24%）患者在疼痛发作12小时后就诊（P = 0.0127）。从入院到再灌注的时间没有显著延迟（P = 0.9833）。早期和晚期就诊者之间以及大流行期间和大流行前时期之间，在院内死亡、中风或住院时间方面没有差异。
总之，本研究发现与大流行前相比，大流行期间患者因AMI寻求医疗治疗的等待时间显著更长，并且针对大流行的特定方案可能会延迟NSTEMI患者的血管重建。这些发现导致从症状发作到血管重建的时间增加了三倍多，增加了未来诸如左心室功能障碍和心血管死亡等并发症的风险。应努力提高患者对延迟就诊后果的认识，并在医院评估策略和尽量缩短总缺血时间的目标之间找到平衡。
