Smith Megan, Singh Aniruddha, McElroy Douglas, Mittal Shilpi, Pham Richard
Department ofCardiology, University of Kentucky College of Medicine, Bowling Green, KY 42101, United States.
Department of Biology, Western Kentucky University, Bowling Green, KY 42101, United States.
World J Cardiol. 2021 Apr 26;13(4):76-81. doi: 10.4330/wjc.v13.i4.76.
Coronavirus disease 2019 (COVID-19) may contribute to delayed presentations of acute myocardial infarction. Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes. Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19. Also, standardized personal protective equipment precautions are established for all members of the team, regardless of pending COVID-19 testing which might further add to delays.
To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction (STEMI) during the COVID-19 pandemic to same time cohort from 2019.
All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019. STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded. Primary outcome was major adverse cardiac events (MACE) in-hospital and up to 14 d after STEMI, including death, myocardial infarction, cardiac arrest, or stroke. Significant differences among groups for continuous variables were tested through ANOVA, using SYSTAT, version 13. Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT. Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc (MedCalc Software, Ostend, Belgium).
There was a significantly longer time interval from symptom onset to first medical contact (FMC) in the COVID-19 group ( < 0.02). Time to first electrocardiogram, door-to-balloon time, and FMC to balloon time were not significantly affected. The right coronary artery was the most common culprit for STEMI in both the cohorts. Over 60% of patients had one or more obstructive (> 50%) lesion(s) remote from the culprit site. In-hospital and 14 d MACE were more prevalent in the COVID-19 group ( < 0.01 and < 0.001).
This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.
2019冠状病毒病（COVID-19）可能导致急性心肌梗死就诊延迟。延迟就诊及晚期再灌注常与机械并发症风险增加和不良预后相关。由于每一位急症患者都被视为COVID-19的潜在病例或携带者，因此可能存在内在延迟。此外，为团队所有成员制定了标准化的个人防护设备预防措施，无论COVID-19检测结果如何，这可能会进一步增加延迟。
比较在COVID-19大流行期间到我院就诊的ST段抬高型心肌梗死（STEMI）患者与2019年同期患者的性能指标和临床结局。
将大流行期间到我院就诊的所有STEMI患者与2019年同期匹配队列进行比较。排除症状发作时间不明的STEMI患者和住院STEMI患者。主要结局是STEMI后住院期间及14天内的主要不良心脏事件（MACE），包括死亡、心肌梗死、心脏骤停或中风。使用SYSTAT 13版通过方差分析检验连续变量组间的显著差异。使用SYSTAT通过卡方关联检验比较组间患者特征。使用MedCalc（比利时奥斯坦德MedCalc软件）计算离散变量的相对风险评分及相关显著性检验。
COVID-19组从症状发作到首次医疗接触（FMC）的时间间隔显著更长（<0.02）。首次心电图时间、门球时间和FMC到球囊时间未受到显著影响。两个队列中，右冠状动脉都是STEMI最常见的罪犯血管。超过60%的患者在罪犯血管部位以外有一处或多处阻塞性（>50%）病变。COVID-19组住院期间及14天MACE更为常见（<0.01和<0.001）。
美国这项单学术中心研究表明，在COVID-19大流行期间STEMI患者寻求医疗救治存在延迟，这可能导致更差的临床结局。
