key: cord-0813031-mzj2omdt
authors: Zhang, Feifei; Song, Xuelian; Dang, Yi
title: Experience of ST segment elevation myocardial infarction management during COVID-19 pandemic from the mainland of China
date: 2020-07-25
journal: Cardiovasc Revasc Med
DOI: 10.1016/j.carrev.2020.07.027
sha: fdba2649524b5960e316efd0b254e37a8daeedc0
doc_id: 813031
cord_uid: mzj2omdt

BACKGROUND: The pandemic of COVID-19 has created a crisis in healthcare systems across the globe. This situation would affect the diagnosis and treatment of patients with STEMI. The outbreak was under improved control in the mainland of China. We here describe the impact of this pandemic on STEMI patient's management. METHODS: Information of STEMI patient management was collected from the CPC data reporting platform. We compared these with data of patients from the same period in 2018 and 2019. Also we made an analysis of those characteristics in each month in 2020. RESULTS: There was 51.4% decrease of STEMI patients admitted to hospital during the peak period of COVID-19 epidemic. The ratio of no reperfusion of STEMI patients is more than 10% higher in 2020 than 2018, 2019. The percentage of STEMI patients received fibrinolysis in 2020 was 2 to 3 times higher than that in 2018, 2019, while the volume of PPCI dropped by more than half. The mortality rate of whole cohort and perioperative was the highest in February 2020. CONCLUSIONS: COVID-19 pandemic dramatically reduced the number of STEMI patients attending hospital and delay the time to treatment and consequently, a higher in-hospital mortality. The benefits of thrombolysis during the pandemic remain to be proven.

The outbreak was under improved control and the mainland of China has been through the worst period. We here describe the impact of this pandemic on STEMI patients' management in a single chest pain center (CPC).

We focused on the time period from January 1,2020 to March 31, 2020, when the COVID-19 started outbreaking and declined gradually.

Information of STEMI patients management was collected from the CPC data reporting platform. We compared these with data of patients from the same period in 2018 and 2019. Also we made a comparison of the characteristics from January to May in 2020. Data on patients whether received reperfusion therapy, which strategy was selected, time from symptom to FMC , time from FMC to admission to hospital, time delay from first medical contact (FMC) to needle to delivery thrombosis drug (FMC to N), time delay from door to successful device crossing during PPCI (D to D), the proportion of bypassing the emergency direct arrive catheter room who received PPCI, time delay of cardiac catheterization laboratory (CCL) activation, length of stay, perioperative death during PPCI and total deaths of the whole cohort were gathered. The study was approved by the ethical committee of Hebei General Hospital.

As shown in table 1, the number of STEMI patients admitted to our hospital decline in 2020. The ratio of no reperfusion of STEMI patients is more than 10% higher in 2020 than 2018, 2019. The percentage of STEMI patients received fibrinolysis in 2020 was 2 to 3 times higher than that in 2018, 2019, While the volume of PPCI dropped by more than half. Timely reperfusion therapy could reduce mortality, reinfarction, mechanical complications in STEMI patients. It can be concluded from the table the mortality rates of the patients who did not receive reperfusion was 3.1% in 2020, which is higher than 2.1% in 2019 and 2.9% in 2018. The peak mortality was in February in 2020, 7.6%. This trend could be explained as COVID-19 pandemic delay patient to receive standard medical care. A preliminary analysis during the COVID-19 pandemic in the US showed a 38% reduction in STEMI activations of CCL [5] . The reduction in PPCI for STEMI was also observed in Bergamo, Italy (37%) and Madrid, Spanish (50%) [6] . Abbreviations: STEMI = ST segment elevation myocardial infarction；PPCI = primary percutaneous coronary intervention；FMC = first medical contact；FMC to D = first medical contact to door; FMC to N = first medical contact to needle; D to D =

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The authors have no competing interests to declare.