Mao Qi, Zhao Jianhua, Li Youmei, Xie Li, Xiao Han, Wang Ke, Qiu Youzhu, Chen Jianfei, Xu Qiang, Xu Zhonglin, Yu Yang, Zhang Ying, Li Qiang, Pang Xiaohua, Li Zhenggong, Ran Boli, Zhang Zhihui, Li Zhifeng, Zeng Chunyu, Tong Shifei, Jin Jun, Huang Lan, Zhao Xiaohui
Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China.
Department of Cardiology, People's Hospital of Banan District, Chongqing, China.
Front Cardiovasc Med. 2021 Jul 22;8:698923. doi: 10.3389/fcvm.2021.698923. eCollection 2021.
The COVID-19 pandemic placed heavy burdens on emergency care and posed severe challenges to ST-segment-elevation myocardial infarction (STEMI) treatment. This study aimed to investigate the impact of COVID-19 pandemic on mechanical reperfusion characteristics in STEMI undergoing primary percutaneous coronary intervention (PPCI) in a non-epicenter region. STEMI cases undergoing PPCI from January 23 to March 29 between 2019 and 2020 were retrospectively compared. PPCI parameters mainly included total ischemic time (TIT), the period from symptom onset to first medical contact (S-to-FMC), the period from FMC to wire (FMC-to-W) and the period from door to wire (D-to-W). Furthermore, the association of COVID-19 pandemic with delayed PPCI risk was further analyzed. A total of 14 PPCI centers were included, with 100 and 220 STEMI cases undergoing PPCI in 2020 and 2019, respectively. As compared to 2019, significant prolongations occurred in reperfusion procedures ( < 0.001) including TIT (420 vs. 264 min), S-to-FMC (5 vs. 3 h), FMC-to-W (113 vs. 95 min) and D-to-W (83 vs. 65 min). Consistently, delayed reperfusion surged including TIT ≥ 12 h (22.0 vs.3.6%), FMC-to-W ≥ 120 min (34.0 vs. 6.8%) and D-to-W ≥ 90 min (19.0 vs. 4.1%). During the pandemic, the patients with FMC-to-W ≥ 120 min had longer durations in FMC to ECG completed (6 vs. 5 min, = 0.007), FMC to DAPT (24 vs. 21 min, = 0.001), catheter arrival to wire (54 vs. 43 min, < 0.001) and D-to-W (91 vs. 78 min, < 0.001). The pandemic was significantly associated with high risk of delayed PPCI (OR = 7.040, 95% CI 3.610-13.729, < 0.001). Even in a non-epicenter region, the risk of delayed STEMI reperfusion significantly increased due to cumulative impact of multiple procedures prolongation.
新冠疫情给急诊护理带来了沉重负担，给ST段抬高型心肌梗死（STEMI）的治疗带来了严峻挑战。本研究旨在调查新冠疫情对非疫情中心地区接受直接经皮冠状动脉介入治疗（PPCI）的STEMI患者机械再灌注特征的影响。对2019年1月23日至2020年3月29日期间接受PPCI的STEMI病例进行回顾性比较。PPCI参数主要包括总缺血时间（TIT）、症状发作至首次医疗接触（S-to-FMC）的时间、首次医疗接触至导丝通过（FMC-to-W）的时间以及入院至导丝通过（D-to-W）的时间。此外，进一步分析了新冠疫情与延迟PPCI风险的关联。共纳入14个PPCI中心，2020年和2019年分别有100例和220例STEMI患者接受了PPCI。与2019年相比，再灌注过程（<0.001）出现了显著延长，包括TIT（420分钟对264分钟）、S-to-FMC（5小时对3小时）、FMC-to-W（113分钟对95分钟）和D-to-W（83分钟对65分钟）。同样，延迟再灌注情况激增，包括TIT≥12小时（22.0%对3.6%）、FMC-to-W≥120分钟（34.0%对6.8%）和D-to-W≥90分钟（19.0%对4.1%）。在疫情期间，FMC-to-W≥120分钟的患者在FMC至心电图完成时间（6分钟对5分钟，=0.007）、FMC至双联抗血小板治疗时间（24分钟对21分钟，=0.001）、导管到达至导丝通过时间（54分钟对43分钟，<0.001）和D-to-W时间（91分钟对78分钟，<0.001）方面持续时间更长。疫情与延迟PPCI的高风险显著相关（OR=7.040，95%CI 3.610-13.729，<0.001）。即使在非疫情中心地区，由于多个过程延长的累积影响，STEMI延迟再灌注的风险也显著增加。
