key: cord-0779996-gbf899j1
authors: Li, Yi-Heng; Huang, Wei-Chun; Hwang, Juey-Jen
title: No Reduction of ST-segment Elevation Myocardial Infarction Admission in Taiwan During Coronavirus Pandemic
date: 2020-06-27
journal: Am J Cardiol
DOI: 10.1016/j.amjcard.2020.06.030
sha: 2f234e136e384b416cccee5e89805dc4a9fe395b
doc_id: 779996
cord_uid: gbf899j1

nan

Recently, a significant reduction in ST-elevation myocardial infarction (STEMI) admission was reported from the United States and Europe where the coronavirus disease (COVID-19) caused a public health crisis. 1, 2 The door-to-device time of primary percutaneous coronary intervention (PPCI) was also delayed. 3 The COVID-19 pandemic has a much less impact in Taiwan because early actions to prevent community outbreak were taken from January 2020 when mystery pneumonia in Wuhan, China was found. 4 As to May 2020, there were only 443 confirmed cases in 23 million population in Taiwan and most patients were imported cases from February to April, 2020. The public health response in Taiwan became a role model to flatten the infection curve of COVID-19.

We conducted a multicenter, observational, nationwide survey to collect data of STEMI cases from February 1 to April 30, 2020 (COVID-19 pandemic period) and compared the data with the same period in 2019. The following data were collected:

(1) the number of patients admitted for STEMI, (2) symptom onset-to-door time, (3) door-to-device time of PPCI, and (4) use of fibrinolytic therapy. Symptom onset-to-door time is defined as the time between first patient-or family-reported symptom onset and patients' arrival at the hospitals. Door-to-device time is defined as the time between patients' arrival at the hospitals and successful wire crossing or balloon inflation during PPCI. Data were presented with mean ± standard deviation for average case number or medians and interquartile ranges for times. pandemic, none of the hospitals used fibrinolytic therapy and 9 out of 40 (22.5%) hospitals had experiences of wearing personal protective equipment to perform PCI for suspected cases with COVID-19.

In Taiwan, adequate public health strategy diminished the impact of COVID-19 pandemic on healthcare system. There was no significant influence on admission and care quality of STEMI. Registry data in Taiwan showed the median door-to-device time was 96 min in 2010 and 71 min in 2015. 5 The time was continuously decreased to 66 min in 2020 even in the COVID-19 pandemic. However, there was a significant delay of seeking medical help. The symptom onset-to-door time increased by 27% in 2020 compared with the equivalent months in 2019. There were no in-hospital transmission and healthcare personnel infection of COVID-19 in Taiwan. It is likely that the impression of virus spread from hospitalized patients with COVID-19 made patients reluctant to go to hospitals and delay in seeking care. In Italy, a similar reduction of STEMI admission was found in central and south parts where there were less cases of COVID-19 compared to the most affected north part. 1 The risk of mortality and complications of STEMI also increased significantly. 1 Further study is needed to evaluate whether delay in treatment also cause worse prognosis of STEMI in Taiwan. In conclusion, although there was no reduction of STEMI admission in Taiwan, a significant delay for medical help was found during the COVID-19

pandemic. Further actions are necessary to avoid the negative impact of COVID-19 pandemic on care of STEMI.

Società Italiana di Cardiologia and the CCU Academy investigators group. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

The Covid-19 pandemic and the incidence of acute myocardial infarction

Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in

Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing

The Taiwan Heart Registries: its influence on cardiovascular patient care

Table 1. The case number and primary PCI for STEMI before and after COVID-19 outbreak in Taiwan

COVID-19, coronavirus disease

PCI, percutaneous coronary intervention

ST-segment elevation myocardial infarction