Hodas Roxana, Benedek Imre, Rat Nora, Kovacs Istvan, Chitu Monica, Benedek Theodora
Pharmacy, Science and Technology of Targu Mures, George Emil Palade University of Medicine, 540142 Tirgu Mures, Romania.
Clinic of Cardiology, Emergency Clinical County Hospital, 540136 Tirgu Mures, Romania.
Life (Basel). 2021 Sep 24;11(10):1004. doi: 10.3390/life11101004.
The COVID-19 pandemic has had a major impact on cardiovascular emergencies. The aim of this study was to investigate the impact of the COVID-19 pandemic on a regional network for management of ST-segment elevation acute myocardial infarction (STEMI).
We report a single center's experience of patients hospitalized for ACS in a high-volume hub of a STEMI network during the lockdown (in the first pandemic trimester), compared with the same time interval of the previous year and including all consecutive patients referred for an AMI during the second trimester of 2020 (from April to June) or during the same time interval of the previous year, 2019.
The absolute number of hospital admissions for AMI decreased by 22.3%, while the non-AMI hospitalizations decreased by 77.14% in Q2-2020 compared to Q2-2019 (210 vs. 48, < 0.0001). As a consequence, the percentage of AMI cases from the total number of hospital admission increased from 38% to 68% ( < 0.0001), AMI becoming the dominant pathology. In the STEMI group there was a significant reduction of 55% in the absolute number of late STEMI presentations. Functionality of the STEMI network at the hub level did not present a significant alteration with only a minor increase in the door-to-balloon time, from 34 min to 41 min. However, at the level of the network we recorded a lower number of critical cases transferred to the interventional center, with a dramatic reduction of 56.1% in the number of critical STEMI cases arriving in the acute cardiac care unit (17.0% vs. 7.3%, -0.04 for KILLIP class III, and 21.17% vs. 11.11%, = 0.08 for resuscitated out of hospital cardiac arrest).
The COVID-19 outbreak did not have a major impact on the interventional center's functionality, but it limited the capacity of the regional STEMI network to bring the critical patient with complicated STEMI to the cathlab in time during the first months of the lockdown. Even a very well-functioning STEMI network like the one in Central Romania had difficulties bringing the most critical STEMI cases to the cathlab in time.
新型冠状病毒肺炎大流行对心血管急症产生了重大影响。本研究的目的是调查新型冠状病毒肺炎大流行对一个ST段抬高型急性心肌梗死（STEMI）区域管理网络的影响。
我们报告了一家单一中心在封锁期间（大流行的第一个三个月），在一个STEMI网络的高容量中心，因急性冠状动脉综合征（ACS）住院患者的经验，并与上一年的同一时间间隔进行比较，包括2020年第二个三个月（4月至6月）或2019年上一年同一时间间隔内所有连续转诊的急性心肌梗死患者。
与2019年第二季度相比，2020年第二季度急性心肌梗死的住院绝对人数下降了22.3%，而非急性心肌梗死住院人数下降了77.14%（210例对48例，<0.0001）。因此，急性心肌梗死病例占总住院人数的百分比从38%增加到68%（<0.0001），急性心肌梗死成为主要病理类型。在STEMI组中，晚期STEMI表现的绝对人数显著减少了55%。枢纽级STEMI网络的功能没有出现显著改变，门球时间仅略有增加，从34分钟增加到41分钟。然而，在网络层面，我们记录到转诊至介入中心的危急病例数量减少，到达急性心脏护理病房的危急STEMI病例数量大幅减少了56.1%（Killip III级为17.0%对7.3%，P = 0.04；院外心脏骤停复苏患者为21.17%对11.11%，P = 0.08）。
新型冠状病毒肺炎疫情对介入中心的功能没有重大影响，但在封锁的头几个月里，它限制了区域STEMI网络及时将患有复杂STEMI的危急患者送往导管室的能力。即使是像罗马尼亚中部那样运作良好的STEMI网络，也难以及时将最危急的STEMI病例送往导管室。
