key: cord-265098-u5qssib9 authors: Fu, Xin-yan; Shen, Xiang-feng; Cheng, Yong-ran; Zhou, Meng-Yun; Ye, Lan; Feng, Zhan-hui; Xu, Zhao; Chen, Juan; Wang, Ming-Wei; Zhang, Xing-wei title: Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction date: 2020-09-17 journal: Am J Emerg Med DOI: 10.1016/j.ajem.2020.09.038 sha: doc_id: 265098 cord_uid: u5qssib9 OBJECTIVE: To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. METHODS: We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF),the incidence of major adverse cardiovascular and cerebrovascular events (MACCE),Kaplan-Meier survival curves during the 28 days after the operation. RESULTS: The times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05). CONCLUSION: The pre-hospital and in-hospital treatment times of STEMI patients during the COVID-19 epidemic were longer than those before the epidemic. Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis. Multiple cases of pneumonia patients, infected with a novel coronavirus (SARS-CoV-2), were discovered in Wuhan City, Hubei, China, since December 2019. [1, 2] With the spread of the epidemic, confirmed cases were found in other provinces in China and most countries around the world. As of May 10, 2020, there were 3,917,366 confirmed cases worldwide, and 274,361 deaths, far exceeding the number of people affected by atypical pneumonia or the Middle East respiratory syndrome (MERS). [3, 4] The National Health Commission of China quickly announced the disease as a Class B infectious disease, as stipulated in the Chinese law on the Prevention and Control of Infectious Diseases. It also required the activation of preventive and control measures of Class A infectious diseases. [5] On January 23, 2020, the closure of Wuhan City was announced. Before this, on January 20, 2020, the Hangzhou Chest Pain Center (CPC) has formulated a procedure for patient consultation under the preventive and control measures of COVID-19 ( Figure 1 ). The epidemic occurred during the transition from winter to spring, a ( Figure 2 ), striving to prevent and control the epidemic while optimizing the treatment. This action followed the STEMI merger strategy for the management of SARS-CoV-2 infection in the People's Hospital of Wuhan University. [8] As part of the improved cooperation with the hospital, we carried out fever diagnoses and disease treatment. However, we hypothesized that the COVID-19 epidemic might have interfered with diagnosing and treating acute myocardial infarction. To clarify this issue, we performed a retrospective study comparing STEMI patients at the Hangzhou CPC during the COVID-19 epidemic (January 20 to April 20, 2020) with those during the corresponding period in 2019. We aimed to explore the impact of COVID-19 on the treatment time of STEMI patients and provide a solid base in support of standardizing the treatment process of STEMI patients during an epidemic situation such as COVID-19. Clinical data of STEMI patients who visited the Hangzhou CPC were collected. MACCE events included non-fatal myocardial infarction, cardiac death, target vessel revascularization, and stroke. Cardiac death refers to death due to myocardial ischemia, leading to cardiac arrest before the loss of other functions; target vessel revascularization refers to lesions in the original stent area and the coronary arteries within 5 mm from both ends of such stent. It also includes lesions in the area outside the target lesion, located in the main branch corresponding to the revascularized coronary artery; stroke refers to cerebral hemorrhage or cerebral infarction. [10] This study was approved by the Human Study Ethics Committee of the Affiliated Hospital of Hangzhou Normal University. Data analysis was performed using the R program (v3.60). An independent sample t-test was used for group comparisons. The Kaplan-Meier survival curve was used to estimate the survival rate. Wilcoxon signed-rank test was used to compare the J o u r n a l P r e -p r o o f Journal Pre-proof survival rate between the two groups. Continuous variables are presented as mean ± standard deviation. Differences with P < 0.05 were considered statistically significant. A total of 24 patients in the 2020 group and 29 patients in the 2019 group were showed in Table 1 . The baseline data and risk factors relating to coronary heart disease were analyzed in both groups.There were no statistical significance in terms of age,sex,drinking history, smoking history, hypertension, diabetes, hypercholesterolemia, obesity, and family history of coronary heart disease in the two groups. With one patient in each group having a history of myocardial infarction, the difference was insignificant. The groups also did not differ in the myocardial infarction location, Killip classification, and LVEF. Based on these results, we think that the reasons for the delay in STEMI treatment times can be summarized along the following lines. First, patients delayed their visit to the hospital because they feared becoming infected with SARS-CoV-2. This delay resulted in a significant prolongation of the SO-to-FMC time. During the epidemic, ordinary patients with non-emergency cardiovascular diseases were advised to avoid hospital admission as much as possible. After the epidemic was contained, they were admitted to the hospital for treatment. The patients, especially the elderly, often cannot distinguish between emergency and non-emergency events. Moreover, the patients were extremely anxious about the spread of COVID-19, so they delayed seeking medical help, and attempted to relieve the chest pain symptoms by taking quick-acting rescue pills or other drugs. These patients did not call for help until it was already intolerable. Second, after the patients have arrived at the hospital gates, the FMC-to-ECG and D-to-B times were further prolonged because of the COVID-19 screening of the patient and the accompanying family members during the epidemic. 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Coron Artery Dis Protocol of the China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP): a 10-year project to improve quality of care by building up a regional STEMI care network ST-segment elevation myocardial infarction Effects of target value management for quality control indexes in chest pain center on efficiency and effectiveness of in-hospital treatment for STEMI patients