Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, PR China.
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, PR China; Department of Internal Medicine, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, PR China; Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing 100069, PR China.
Am J Emerg Med. 2022 Mar;53:68-72. doi: 10.1016/j.ajem.2021.11.034. Epub 2021 Nov 24.
Strict control measures under the COVID epidemic have brought an inevitable impact on ST-segment elevation myocardial infarction (STEMI)'s emergency treatment. We investigated the impact of the COVID on the treatment of patients with STEMI undergoing primary PCI.
In this single center cohort study, we selected a time frame of 6 month after declaration of COVID-19 infection (Jan 24-July 24, 2020); a group of STEMI patients in the same period of 2019 was used as control. Finally, a total of 246 STEMI patients, who were underwent primary PCI, were enrolled into the study (136 non COVID-19 outbreak periods and 110 COVID-19 outbreak periods). The impact of COVID on the time of symptom onset to the first medical contact (symptom-to-FMC) and door to balloon (D-to-B) was investigated. Moreover, the primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, heart failure and malignant arrhythmia.
Compared with the same period in 2019, there was a 19% decrease in the total number of STEMI patients undergoing primary PCI at the peak of the pandemic in 2020. The delay in symptom-to-FMC was significantly longer in COVID Outbreak period (180 [68.75, 342] vs 120 [60,240] min, P = 0.003), and the D-to-B times increased significantly (148 [115-190] vs 84 [70-120] min, P < 0.001). However, among patients with STEMI, MACE was similar in both time periods (18.3% vs 25.7%, p = 0.168). On multivariable analysis, COVID was not independently associated with MACE; the history of diabetes, left main disease and age>65 years were the strongest predictors of MACE in the overall population.
The COVID pandemic was not independently associated with MACE; suggesting that active primary PCI treatment preserved high-quality standards even when challenged by a severe epidemic.
URL: https://ClinicalTrials.gov Unique identifier: NCT04427735.
新冠疫情下的严格管控措施对 ST 段抬高型心肌梗死（STEMI）的紧急治疗带来了必然影响。我们旨在研究新冠疫情对行直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者的治疗影响。
本单中心队列研究选取了新冠病毒感染宣布后的 6 个月时间段（2020 年 1 月 24 日至 7 月 24 日）；并选取同期 2019 年的一组 STEMI 患者作为对照。最终，共纳入了 246 例行直接 PCI 的 STEMI 患者（非新冠疫情爆发期 136 例，新冠疫情爆发期 110 例）。我们研究了新冠疫情对症状发作至首次医疗接触（症状至 FMC）和门球时间（D-to-B）的影响。此外，主要终点为院内主要不良心脏事件（MACE），定义为心脏死亡、心力衰竭和恶性心律失常的复合终点。
与 2019 年同期相比，2020 年疫情高峰期行直接 PCI 的 STEMI 患者总数减少了 19%。新冠疫情爆发期症状至 FMC 明显延迟（180[68.75，342]min 比 120[60，240]min，P=0.003），D-to-B 时间显著增加（148[115-190]min 比 84[70-120]min，P<0.001）。然而，在 STEMI 患者中，两个时期的 MACE 发生率相似（18.3%比 25.7%，p=0.168）。多变量分析显示，COVID 与 MACE 无独立相关性；糖尿病史、左主干病变和年龄>65 岁是总体人群中 MACE 的最强预测因素。
新冠疫情与 MACE 无独立相关性；提示即使在严重疫情的挑战下，积极的直接 PCI 治疗仍能保持高质量标准。
网址：https://ClinicalTrials.gov 唯一标识符：NCT04427735。
