Chou San-Fang, Hsieh Chun-Yu, Tsai Kuang-Chau, Liu Yuan-Hung, Fan Chieh-Min, Mi Le Jie-Ren, Jaw Fu-Shan, Chang Chung-Ta, Sim Shyh-Shyong, Wu Yen-Wen, Tai Ting-Li, Chen Kuan-Chang, Wu Yuan-Hui, Hsieh Chien-Chieh
Department of Medical Research.
Department of Cardiovascular Surgery, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Acta Cardiol Sin. 2025 Jan;41(1):121-129. doi: 10.6515/ACS.202501_41(1).20241021A.
Prompt primary percutaneous coronary intervention (pPCI) is crucial for the prognosis and reduction of myocardial damage in ST-segment elevation myocardial infarction (STEMI) patients. The Coronavirus Disease 2019 (COVID-19) pandemic had multifaceted impacts on healthcare. This study assessed the effects of the pandemic on pPCI procedures and clinical outcomes in emergency STEMI patients.
This retrospective, single-center study analyzed STEMI patients who underwent pPCI from February 2019 to January 2022. The COVID-19 pandemic was categorized into three periods: pre-COVID-19 (Period-I), early-pandemic (Period-II), and epidemic (Period-III). The impacts on Door-to-Device time, its segments, and clinical outcomes were analyzed using Statistical Package for the Social Sciences.
A total of 404 STEMI patients were included, with a reduced number in Period-III. Compared to Period-I, the time intervals of Door-to-electrocardiogram (ECG), ECG-to-Cardiac Catheterization Laboratory Activation (CCLA), and CCLA-to-Cardiac Catheterization Laboratory Door in Period III were extended by 0.62 minutes (p = 0.006), 3.30 minutes (p = 0.009), and 9.65 minutes (p < 0.001), respectively. In contrast, the Angio-to-Device time was shorter in Period- II and III by 2.60 and 4.08 minutes (p < 0.001), respectively. Overall Door-to-Device time increased by 10.06 minutes (p < 0.001) in Period-III but decreased by 3.67 minutes in Period-II (p = 0.017). The odds of achieving a Door-to-Device time ≤ 90 minutes decreased by 70% in Period-III (p = 0.002). Clinical outcomes, including intensive care unit stay, hospital stay, in-hospital mortality, and 30-day readmission rate, remained stable across periods.
The COVID-19 pandemic had various effects on different segments of the Door-to-Device procedure, and they were influenced by the complex interplay between infection control measures and clinical workflow. The stability of clinical outcomes reflects the resilience and effective adaptations of the healthcare system during the pandemic.
对于ST段抬高型心肌梗死（STEMI）患者，及时进行直接经皮冠状动脉介入治疗（pPCI）对于改善预后和减少心肌损伤至关重要。2019年冠状病毒病（COVID-19）大流行对医疗保健产生了多方面的影响。本研究评估了大流行对急诊STEMI患者pPCI手术及临床结局的影响。
这项回顾性单中心研究分析了2019年2月至2022年1月期间接受pPCI的STEMI患者。COVID-19大流行分为三个时期：COVID-19之前（时期I）、大流行早期（时期II）和流行期（时期III）。使用社会科学统计软件包分析对门到设备时间及其各阶段以及临床结局的影响。
共纳入404例STEMI患者，时期III的患者数量减少。与时期I相比，时期III的门到心电图（ECG）、ECG到心脏导管实验室激活（CCLA）以及CCLA到心脏导管实验室门的时间间隔分别延长了0.62分钟（p = 0.006）、3.30分钟（p = 0.009）和9.65分钟（p < 0.001）。相比之下，时期II和III的血管造影到设备时间分别缩短了2.60分钟和4.08分钟（p < 0.001）。时期III的总体门到设备时间增加了10.06分钟（p < 0.001），而时期II减少了3.67分钟（p = 0.017）。时期III实现门到设备时间≤90分钟的几率降低了70%（p = 0.002）。包括重症监护病房住院时间、住院时间、住院死亡率和30天再入院率在内的临床结局在各时期保持稳定。
COVID-19大流行对门到设备流程的不同阶段产生了多种影响，这些影响受到感染控制措施与临床工作流程之间复杂相互作用的影响。临床结局的稳定性反映了大流行期间医疗系统的适应能力和有效调整。
