Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia.
BMJ Open. 2024 Oct 14;14(10):e079060. doi: 10.1136/bmjopen-2023-079060.
This study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern and treatment outcome.
This is a retrospective cohort study in which medical records of hospitalised patients with ACS were reviewed.
Three hospitals in Yogyakarta, Indonesia.
Patients hospitalised with ACS during two pandemic periods (first pandemic period: March-August 2020; second pandemic period: March-August 2021) and prepandemic period (March-August 2019).
Time to treatment, treatment pattern and treatment outcome.
A total of 598 patients with ST-elevation myocardial infarction (STEMI) and 615 with non-ST-elevation ACS were identified. Of these, 313, 484 and 416 were identified during the prepandemic period, first pandemic period and second pandemic period, respectively. For STEMI, the proportion of patients with a delay from symptom onset to first medical contact (FMC) was significantly higher during the second pandemic period as compared with the prepandemic period (47.7% vs 32.0%, OR=1.84, 95% CI 1.18, 2.85). The proportion of patients with STEMI with delayed door-to-balloon (D2B) time was significantly higher during the second pandemic period as compared with the prepandemic period (99.4% vs 92.9%, OR=13.08, 95% CI 1.57, 108.73). Significantly longer mean total ischaemic time (45.85 hours vs 30.29 hours, mean difference=14.56, 95% CI 1.85, 27.28) was observed among patients with STEMI during the second year of the pandemic as compared with the prepandemic period. No significant differences between the prepandemic period and the first pandemic period were found in terms of proportion of patients with STEMI with a delay in time from symptom onset to FMC, delayed D2B time and total ischaemic time. Only Global Registry of Acute Coronary Events risk score (OR=1.04, 95% CI 1.03, 1.05) was a significant predictor of in-hospital mortality in the multivariate analysis.
This study suggests a significant impact of the COVID-19 pandemic on time to treatment among patients with ACS. Health systems need to be well prepared to support effective and timely treatment of patients with ACS during future crisis.
本研究旨在评估 COVID-19 大流行对印度尼西亚日惹急性冠状动脉综合征（ACS）管理的影响，具体涉及治疗时间、治疗模式和治疗结局。
这是一项回顾性队列研究，对住院 ACS 患者的病历进行了审查。
印度尼西亚日惹的三家医院。
在两个大流行期间（第一大流行期间：2020 年 3 月至 8 月；第二大流行期间：2021 年 3 月至 8 月）和大流行前期间（2019 年 3 月至 8 月）住院的 ACS 患者。
治疗时间、治疗模式和治疗结局。
共确定了 598 例 ST 段抬高型心肌梗死（STEMI）和 615 例非 ST 段抬高型 ACS 患者。其中，313、484 和 416 例分别在大流行前、第一大流行和第二大流行期间确定。对于 STEMI，与大流行前相比，第二大流行期间从症状发作到首次医疗接触（FMC）的患者延迟比例显著更高（47.7% vs 32.0%，OR=1.84，95%CI 1.18，2.85）。第二大流行期间 STEMI 患者的延迟球囊扩张（D2B）时间比例显著高于大流行前（99.4% vs 92.9%，OR=13.08，95%CI 1.57，108.73）。与大流行前相比，STEMI 患者的平均总缺血时间明显延长（45.85 小时 vs 30.29 小时，平均差异=14.56，95%CI 1.85，27.28）。在 STEMI 患者中，从症状发作到 FMC 的时间延迟、D2B 时间延迟和总缺血时间延迟的比例，在大流行前与第一大流行期间之间无显著差异。仅全球急性冠状动脉事件登记处风险评分（OR=1.04，95%CI 1.03，1.05）是多变量分析中住院死亡率的显著预测因子。
本研究表明 COVID-19 大流行对 ACS 患者的治疗时间有重大影响。卫生系统需要做好充分准备，以在未来的危机中为 ACS 患者提供有效和及时的治疗。
