Lertsanguansinchai Piyoros, Chokesuwattanaskul Ronpichai, Limjaroen Thitima, Wanlapakorn Chaisiri, Lertsuwunseri Vorarit, Athisakul Siriporn, Chaipromprasit Jarkarpun, Udayachalerm Wasan, Buddhari Wacin, Srimahachota Suphot
Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok 10330, Thailand.
Cardiology Center, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok 10210, Thailand.
Biomedicines. 2022 Oct 22;10(11):2671. doi: 10.3390/biomedicines10112671.
Background: Nowadays, current evidence on the effects of the COVID-19 outbreak on ST-elevation myocardial infarction (STEMI) patients is discrepant. The aim of this study was to compare and identify any changes in STEMI patients between the pre-COVID-19 period and during the COVID-19 outbreak. Methods: We conducted a retrospective cohort study to evaluate consecutive STEMI patients admitted from 1 September 2018 to 30 September 2021. We designated 14 March 2020 as the commencement of the COVID-19 outbreak in Thailand. Results: A total of 513 consecutive STEMI patients were included in this study: 330 (64%) admitted during the pre-COVID-19 outbreak period and 183 (36%) admitted during the COVID-19 outbreak. There was a significant 45% decline in the number of STEMI cases admitted during the COVID-19 outbreak period. During the outbreak, STEMI patients had significantly increased intra-aortic balloon pump (IABP) insertion (23% vs. 15%, p-value = 0.004), higher high-sensitivity troponin T level (11,150 vs. 5213, p-value < 0.001), and lower pre- and post-PCI TIMI flow. The time-to-diagnosis (59 vs. 7 min, p-value < 0.001), pain-to-first medical contact (FMC) time (250 vs. 214 min, p-value = 0.020), FMC-to-wire-crossing time (39 vs. 23 min, p-value < 0.001), and pain-to-wire-crossing time (292 vs. 242 min, p-value = 0.005) were increased in STEMI patients during the outbreak compared with pre-outbreak. There was no statistical difference in in-hospital mortality between both periods (p-value = 0.639). Conclusions: During the COVID-19 outbreak, there was a significant decline in the total number of admitted STEMI cases. Unfortunately, the time-to-diagnosis, pain-to-FMC time, FMC-to-wire-crossing time, and pain-to-wire-crossing time were significantly delayed during the COVID-19 outbreak. However, in-hospital mortality showed no significant differences between these two time periods. Highlights: 45% decline in the number of STEMI cases admitted and a significant delay in the treatment timeline during the COVID-19 outbreak. In-hospital mortality showed no significant difference between these two periods. Our study will motivate healthcare professionals to optimize treatments, screenings, and infectious control protocols to reduce the time from the onset of chest pain to wire crossing in STEMI patients during the outbreak.
目前，关于新冠疫情对ST段抬高型心肌梗死（STEMI）患者影响的现有证据存在差异。本研究的目的是比较并确定新冠疫情前和疫情期间STEMI患者的任何变化。方法：我们进行了一项回顾性队列研究，以评估2018年9月1日至2021年9月30日收治的连续性STEMI患者。我们将2020年3月14日指定为泰国新冠疫情的开始时间。结果：本研究共纳入513例连续性STEMI患者：330例（64%）在新冠疫情前收治，183例（36%）在新冠疫情期间收治。新冠疫情期间收治的STEMI病例数显著下降了45%。疫情期间，STEMI患者主动脉内球囊反搏（IABP）置入显著增加（23%对15%，p值=0.004），高敏肌钙蛋白T水平更高（11150对5213，p值<0.001），且PCI术前和术后TIMI血流更低。与疫情前相比，疫情期间STEMI患者的诊断时间（59对7分钟，p值<0.001）、疼痛至首次医疗接触（FMC）时间（250对214分钟，p值=0.020）、FMC至导丝通过时间（39对23分钟，p值<0.001）以及疼痛至导丝通过时间（292对242分钟，p值=0.005）均增加。两个时期的院内死亡率无统计学差异（p值=0.639）。结论：在新冠疫情期间，收治的STEMI病例总数显著下降。不幸的是，在新冠疫情期间，诊断时间、疼痛至FMC时间、FMC至导丝通过时间以及疼痛至导丝通过时间均显著延迟。然而，这两个时期的院内死亡率无显著差异。要点：新冠疫情期间STEMI病例数下降45%，治疗时间线显著延迟。这两个时期的院内死亡率无显著差异。我们的研究将促使医疗保健专业人员优化治疗、筛查和感染控制方案，以减少疫情期间STEMI患者从胸痛发作到导丝通过的时间。
