Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Open Heart. 2021 Feb;8(1). doi: 10.1136/openhrt-2020-001497.
Although there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.
This single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.
We analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.
Following the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.
虽然有地区报告称，COVID-19 大流行与急性心肌梗死发作和经皮冠状动脉介入治疗（PCI）减少有关，但对于 COVID-19 大流行对 ST 段抬高型心肌梗死（STEMI）机械并发症和死亡率的影响知之甚少。
这项单中心回顾性队列研究分析了日本政府于 2020 年 4 月 7 日宣布 COVID-19 大流行紧急状态前后，STEMI 患者的就诊情况、机械并发症发生率和死亡率。
我们分析了在宣布前住院的 359 例 STEMI 患者和宣布后住院的 63 例 STEMI 患者。与宣布前相比，宣布后晚期就诊的患者比例明显更高（25.4% vs 14.2%，p=0.03）。COVID-19 大流行期间晚期就诊的发生率明显高于宣布前（发病率比（IRR），2.41；95%CI，1.37 至 4.05；p=0.001，即使在调整月份后（IRR，2.61；95%CI，1.33 至 5.13；p<0.01）。与宣布前相比，宣布后接受直接 PCI 的患者明显减少（68.3% vs 82.5%，p=0.009）。STEMI 机械并发症的发生在宣布前的 359 例患者中有 13 例（3.6%），在宣布后的 63 例患者中有 9 例（p<0.001）。然而，住院期间死亡率（宣布前为 6.2%，宣布后为 6.4%，p=0.95）相当。
COVID-19 大流行后，STEMI 机械并发症的发生率增加。指导人们待在家里，而没有有效地教育他们在出现心脏病发作症状时立即寻求医疗救助，可能会使 STEMI 患者的预后恶化。
