key: cord-1053082-bd6t00rp
authors: Barbieri, Lucia; Tumminello, Gabriele; Lucreziotti, Stefano; Gentile, Domitilla; Centola, Marco; Conconi, Barbara; Carlà, Matteo; Mafrici, Antonio; Carugo, Stefano
title: Mortality in STEMI patients during the COVID era: has the pandemic changed our clinical practice?
date: 2020-09-10
journal: Cardiovasc Revasc Med
DOI: 10.1016/j.carrev.2020.09.014
sha: a3320e40c46a9cdc3e1bd6c369e6c28ea583cf85
doc_id: 1053082
cord_uid: bd6t00rp

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emergency departments for COVID-19 and for the correct management of other emergency conditions such as ST-elevation myocardial infarction (STEMI) (1) . The STEMI net was reorganized dividing the 55 hospital equipped with cardiac catheterization laboratories offering 24/7 service in to 13 Hub and 42 Spoke centres in order to centralize the resources.

In this study we retrospectively evaluated the treatment of STEMI patients admitted to ASST Santi Paolo e Carlo Hospital in Milan, HUB center according to emergency medical system (EMS) network reorganization, during pandemic compared to a normal life conditions (2) . The study was performed in accordance to the Declaration of Helsinki, all data were collected anonymously and all patients subscribe a disclosure for the use of personal data at hospitalization. The study period was defined between February 20, and April 14, 2020 and we compared clinical, procedural and outcome data of the population during the corresponding period in 2019. The diagnosis of SARS-COV-2 was performed by nasopharyngeal swab test. From a total of 56 STEMI patients we divided our population in two groups according to the revascularization period (n=21 in 2019, n=35 in 2020). The reorganization of the EMS probably explains the increased number of STEMI in our hospital in 2020, despite a reduction in catheterization laboratory activations and of the overall rate of hospital admissions for ACS during pandemic observed in recent studies (3) .

The table displays a detailed overview of clinical, procedural characteristic and main components of STEMI care among the two groups. Interestingly, we did not find any significant difference regarding clinical characteristics in particular for main cardiovascular risk factors, baseline laboratory measurements and STEMI type. The site of diagnosis was more often in a pre-hospital setting during 2020 (74.3% vs 19%, p=0.01) probably due to the very smart reorganization of our regional EMS. Regarding the extension of coronary disease left anterior descending was the most represented in both populations but with a J o u r n a l P r e -p r o o f Journal Pre-proof higher prevalence in 2019 (90.5% vs 58.8%, p=0.01) balanced by a lower right coronary involvement (50% vs 19%, p=0.02). No other significant differences were found in particular regarding cardiogenic shock at admission, out of hospital cardiac arrest, ejection fraction or the percentage of multivessel disease. On the other side in-hospital mortality was most represented in 2020 with 7/35 patients (20%) dead versus 2/21 (9.5%) in 2019 and respiratory impairment, reported in 6/35 (17%) patients in 2020 was absent in 2019.

Interestingly, unlike results from other studies (4) we did not find any difference also 

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