Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
Department of Cardiology, National University Heart Centre Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Int J Qual Health Care. 2023 Jun 1;35(2). doi: 10.1093/intqhc/mzad023.
The COVID -19 pandemic impacted acute myocardial infarction (AMI) attendances, ST-elevation myocardial infarction (STEMI) treatments, and outcomes. We collated data from majority of primary percutaneous coronary intervention (PPCI)-capable public healthcare centres in Singapore to understand the initial impact COVID-19 had on essential time-critical emergency services. We present data comparisons from 'Before Disease Outbreak Response System Condition (DORSCON) Orange', 'DORSCON Orange to start of circuit breaker (CB)', and during the first month of 'CB'. We collected aggregate numbers of weekly elective PCI from four centres and AMI admissions, PPCI, and in-hospital mortality from five centres. Exact door-to-balloon (DTB) times were recorded for one centre; another two reported proportions of DTB times exceeding targets. Median weekly elective PCI cases significantly decreased from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (34 vs 22.5, P = 0.013). Median weekly STEMI admissions and PPCI did not change significantly. In contrast, the median weekly non-STEMI (NSTEMI) admissions decreased significantly from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (59 vs 48, P = 0.005) and were sustained during CB (39 cases). Exact DTB times reported by one centre showed no significant change in the median. Out of three centres, two reported significant increases in the proportion that exceeded DTB targets. In-hospital mortality rates remained static. In Singapore, STEMI and PPCI rates remained stable, while NSTEMI rates decreased during DORSCON Orange and CB. The severe acute respiratory syndrome (SARS) experience may have helped prepare us to maintain essential services such as PPCI during periods of acute healthcare resource strain. However, data must be monitored and increased pandemic preparedness measures must be explored to ensure that AMI care is not adversely affected by continued COVID fluctuations and future pandemics.
新冠疫情对急性心肌梗死（AMI）就诊、ST 段抬高型心肌梗死（STEMI）治疗和结局产生了影响。我们整理了新加坡大多数具备直接经皮冠状动脉介入治疗（PPCI）能力的公立医疗保健中心的数据，以了解新冠疫情对关键急救服务的初始影响。我们展示了“疾病暴发应对系统橙色阶段前（DORSCON 橙色）”“DORSCON 橙色至断路器启动期间”和“断路器实施首月”的数据对比。我们从四个中心收集了每周择期 PPCI 的汇总数据，以及五个中心的 AMI 入院、PPCI 和院内死亡率。一个中心记录了确切的门球时间（DTB），另外两个中心报告了超过目标 DTB 时间的比例。每周择期 PCI 中位数从“DORSCON 橙色前”显著下降至“DORSCON 橙色至断路器启动期间”（34 例 vs 22.5 例，P=0.013）。每周 STEMI 入院和 PPCI 中位数无显著变化。相反，每周非 ST 段抬高型心肌梗死（NSTEMI）入院中位数从“DORSCON 橙色前”显著下降至“DORSCON 橙色至断路器启动期间”（59 例 vs 48 例，P=0.005），并在断路器实施期间持续下降（39 例）。一个中心报告的精确 DTB 时间中位数无显著变化。三个中心中的两个报告了超过 DTB 目标比例的显著增加。院内死亡率保持稳定。在新加坡，STEMI 和 PPCI 率保持稳定，而在 DORSCON 橙色和断路器实施期间，NSTEMI 率下降。严重急性呼吸综合征（SARS）的经验可能帮助我们做好准备，在急性医疗资源紧张时期维持必要服务，如 PPCI。然而，必须监测数据，并探索增加大流行防范措施，以确保 AMI 护理不受持续的新冠波动和未来大流行的不利影响。
