Chammas Lara, Yuan Kevin, Little Stephanie, Roadknight Gail, Varnai Kinga A, Chang Shing Chan, Sze Shirley, Davies Jim, Tsui Andrew, Salih Hizni, Glampson Ben, Papadimitriou Dimitri, Mulla Abdulrahim, Woods Kerrie, O'Gallagher Kevin, Shah Anoop D, Williams Bryan, Asselbergs Folkert W, Mayer Erik, Lee Richard, Herbert Christopher, Johnson Tom, Grant Stuart, Curzen Nick, Shah Ajay M, Perera Divaka, Patel Riyaz S, Channon Keith M, Kaura Amit, Mayet Jamil, Eyre David W, Squire Iain, Kharbanda Raj, Lewis Andrew, Wijesurendra Rohan S
Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
Front Cardiovasc Med. 2024 May 21;11:1406608. doi: 10.3389/fcvm.2024.1406608. eCollection 2024.
The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.
Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).
During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased ( < 0.001), with greater likelihood of troponin testing in both chest pain ( = 0.001) and dyspnoea ( < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both < 0.001), and greater overall mortality of patients ( < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality ( < 0.001), though the temporal risk profile differed.
The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
2019冠状病毒病（COVID-19）大流行与心肌梗死（MI）诊断发病率降低有关，部分原因是患者前往医院就诊的可能性降低。关于疑似MI患者的检查和管理方面的临床决策变化是否也导致了这一现象尚不清楚。
在英国三个向国家卫生研究院健康信息协作中心提供数据的中心进行多中心回顾性队列研究。纳入2020年1月1日至2020年9月1日期间到这些中心急诊科（ED）就诊的患者。根据COVID-19大流行第一波的进程，在此期间定义了三个时间段：大流行前（第1阶段）、封锁期（第2阶段）、封锁后（第3阶段）。
在研究期间，10670名独特的患者因胸痛或呼吸困难到急诊科就诊，其中6928名患者入院。尽管第2阶段急诊科就诊总人数较少，但呼吸困难患者就诊人数增加（<0.001），胸痛（=0.001）和呼吸困难（<0.001）患者进行肌钙蛋白检测的可能性更大。与大流行前时期相比，择期和急诊心脏手术显著减少（均<0.001），患者总体死亡率更高（<0.001）。COVID-19检测呈阳性和/或肌钙蛋白检测结果呈阳性与死亡率增加相关（<0.001），尽管时间风险特征有所不同。
COVID-19大流行的第一波不仅与疑似心肌损伤或MI患者的就诊情况有显著变化，而且与这些患者的检查、管理及结局也有显著变化有关。
