Yang Hongbo, Luo Lingfeng, Cao Jiatian, Song Yanan, Weng Xueyi, Zhang Feng, Zhou Xiaofeng, Huo Yong, Qian Juying, Zheng Yan, Huang Zheyong, Ge Junbo
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai 200032, China.
Department of Occupational and Environmental Health, School of Public Health, Medical College of Soochow University, Suzhou 215123, China.
J Clin Med. 2022 Dec 8;11(24):7290. doi: 10.3390/jcm11247290.
Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenging during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree there will be a residual impact when the COVID-19 pandemic has passed is unclear.
This nationwide retrospective study was based on electronic records of STEMI patients registered in the Chinese Cardiovascular Association Database.
We analyzed 141,375 STEMI patients (including 4871 patients in Hubei province, where 80% of COVID-19 cases in China occurred in 2019-2020) during the pre-outbreak (23 October 2019-22 January 2020), outbreak (23 January 2020-22 April 2020), and post-outbreak (23 April 2020-22 July 2020) periods. In the post-outbreak period in Hubei province, the increased in-hospital mortality dropped to become insignificant (adjusted odds ratio compared to the pre-outbreak level (aOR) 1.40, [95% confidential interval (CI): 0.97-2.03]) and was lower than that in the outbreak period (1.62 [1.09-2.41]). The decreased odds of primary percutaneous coronary intervention (PCI) (0.73 [0.55-0.96]) and timely reperfusion (0.74 [0.62-0.88]) persisted, although they were substantially improved compared to the outbreak period (aOR of primary PCI: 0.23 [0.18-0.30] and timely reperfusion: 0.43 [0.35-0.53]). The residual impact of COVID-19 on STEMI in the post-outbreak period in non-Hubei provinces was insignificant.
Residual pandemic impacts on STEMI management persisted after the first wave of the COVID-19 outbreak in Hubei province, the earliest and hardest hit area in China.
在2019年冠状病毒病（COVID-19）疫情期间，ST段抬高型心肌梗死（STEMI）的快速再灌注一直具有挑战性。COVID-19大流行过去后是否会有残留影响以及影响程度如何尚不清楚。
这项全国性回顾性研究基于中国心血管病学会数据库中登记的STEMI患者的电子记录。
我们分析了疫情前（2019年10月23日至2020年1月22日）、疫情期间（2020年1月23日至2020年4月22日）和疫情后（2020年4月23日至2020年7月22日）期间的141375例STEMI患者（包括湖北省的4871例患者，2019 - 2020年中国80%的COVID-19病例发生在湖北省）。在湖北省疫情后时期，住院死亡率的增加降至无统计学意义（与疫情前水平相比的调整优势比（aOR）为1.40，[95%置信区间（CI）：0.97 - 2.03]），且低于疫情期间（1.62 [1.09 - 2.41]）。直接经皮冠状动脉介入治疗（PCI）（0.73 [0.55 - 0.96]）和及时再灌注（0.74 [0.62 - 0.88]）的优势比降低仍然存在，尽管与疫情期间相比有显著改善（直接PCI的aOR：0.23 [0.18 - 0.30]，及时再灌注的aOR：0.43 [0.35 - 0.53]）。COVID-19对非湖北省疫情后时期STEMI的残留影响无统计学意义。
在中国最早且受影响最严重的地区湖北省，COVID-19第一波疫情爆发后，大流行对STEMI管理的残留影响仍然存在。
