Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Am J Emerg Med. 2022 Oct;60:9-14. doi: 10.1016/j.ajem.2022.07.021. Epub 2022 Jul 16.
Some guidelines had recommended "thrombolysis first" in ST-elevated myocardial infarction (STEMI) during the Coronavirus Disease 2019 (COVID-19) outbreak. The impact of COVID-19 solely on STEMI thrombolysis is lacking as most studies reported outcomes related to percutaneous coronary intervention (PCI) setting. Thus, this study aimed to assess the impact of the COVID-19 pandemic on STEMI thrombolysis outcomes and the Emergency Department's performance in a non-PCI capable centre.
This single-centre retrospective study analysed data on consecutive STEMI patients who received thrombolytic therapy from May 2019 to December 2020 (20 months) in a non-PCI capable tertiary hospital. Total population sampling was used in this study. We compared all patients' characteristics and outcomes ten months before and during the pandemic. Regression models were used to assess the impact of COVID-19 pandemic on door-to-needle time (DNT), mortality, bleeding events, and the number of overnight stays.
We analysed 323 patients with a mean age of 52.9 ± 12.9 years and were predominantly male (n = 280, 88.9%). There was a 12.5% reduction in thrombolysis performed during the pandemic. No significant difference in timing from symptoms onset to thrombolysis and DNT was observed. In-hospital mortality was significantly higher during the pandemic (OR 2.02, 95% CI 1.02-4.00, p = 0.044). Bleeding events post thrombolysis remained stable and there was no significant difference in the number of overnight stays during the pandemic.
STEMI thrombolysis cases were reduced during the COVID-19 pandemic, with an inverse increase in mortality despite the preserved Emergency Department performance in timely thrombolysis.
在 2019 年冠状病毒病（COVID-19）爆发期间，一些指南建议 ST 段抬高型心肌梗死（STEMI）患者行“溶栓优先”策略。由于大多数研究报告的都是经皮冠状动脉介入治疗（PCI）背景下的结局，因此 COVID-19 对 STEMI 溶栓的影响尚未可知。因此，本研究旨在评估 COVID-19 大流行对 STEMI 溶栓结局以及无 PCI 能力中心急诊科表现的影响。
这是一项单中心回顾性研究，分析了 2019 年 5 月至 2020 年 12 月（20 个月）期间在一家无 PCI 能力的三级医院接受溶栓治疗的连续 STEMI 患者的数据。本研究采用全人群抽样。我们比较了大流行前和大流行期间所有患者的特征和结局。回归模型用于评估 COVID-19 大流行对门到针时间（DNT）、死亡率、出血事件和过夜留观次数的影响。
我们分析了 323 例患者，平均年龄为 52.9 ± 12.9 岁，主要为男性（n = 280，88.9%）。大流行期间溶栓治疗的比例下降了 12.5%。从症状发作到溶栓和 DNT 的时间无显著差异。大流行期间住院死亡率显著升高（OR 2.02，95%CI 1.02-4.00，p = 0.044）。溶栓后出血事件保持稳定，大流行期间过夜留观次数无显著差异。
COVID-19 大流行期间 STEMI 溶栓治疗的病例减少，尽管急诊科在及时溶栓方面表现良好，但死亡率呈反式增加。
