Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data

• Autor(a) principal: Azul Freitas, André
• Data de Publicação: 2021
• Outros Autores: Baptista, Rui, Gonçalves, Valdirene, Ferreira, Cátia, Milner, James Bastos, Lourenço, Carolina, Costa, Susana, Franco, Fátima, Monteiro, Sílvia, Gonçalves, Francisco, Gonçalves, Lino
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/105431; https://doi.org/10.1016/j.repc.2020.10.012
• topic: COVID-19; Emergency medical system; SARS-CoV-2; STEMI; COVID-19; Coronavírus 2019; EAMcSST; Sistema de emergência médica

Introduction: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. Methods: We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. Results: A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventila-tion usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction athospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 groupand 7.3% in the 2019 group p=0.200).Conclusion: Despite a lack of significant variation in the absolute number of STEMI admissions,there was an increase in STEMI clinical severity and significantly worse outcomes during theSARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fearof in-hospital infection can partially justify these results and should be the target of futureactions in further waves of the pandemic.