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Zhu Y, Xing W, Wang H, Song J, Sun Z, Li X. Characteristics of patients with ST-segment elevated myocardial infarction (STEMI) at the initial stage of the COVID-19 pandemic: a systematic review and meta-analysis. Infect Dis (Lond) 2021; 53:865-875. [PMID: 34311652 DOI: 10.1080/23744235.2021.1953131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has become a new challenge to the medical system in various countries. The patients with ST-segment elevated myocardial infarction (STEMI) were also affected. METHODS We used a random-effects mode to analyze the differences of the baseline characteristics and therapeutic features between STEMI patients admitted before and after the start of the COVID-19 pandemic. RESULTS Thirty eight studies involving 79,753 patients were included in this analysis. The number of hospitalized STEMI patients decreased by 26% after the start of the COVID-19 pandemic. There were no differences in age, sex, prevalence of diabetes, hypertension, dyslipidemia or percutaneous coronary intervention rate between the STEMI patients before and after the start of the COVID-19 pandemic. However, the STEMI patients admitted after the start of the COVID-19 pandemic had a significantly increased time from symptom onset to first medical contact (standard mean difference: 0.51, 95% confidence interval: 0.24-0.78, p < .001) and an increased in-hospital mortality (odds ratio: 1.70, 95% confidence interval:1.14-2.56, p < .001); The in-hospital mortality of the STEMI patients with COVID-19 was 24% (95% confidence interval: 0.15-0.33); The in-hospital mortality of the STEMI patients with COVID-19 was significantly higher than that of the STEMI patients without COVID-19 at the initial stage of the COVID-19 pandemic (odds ratio: 7.28, 95% confidence interval: 2.75-19.28, p < .001). CONCLUSION The number of admitted STEMI patients was reduced while the in-hospital mortality and the time from symptom onset to first medical contact were increased during the COVID-19 pandemic.
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Affiliation(s)
- Yuhang Zhu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Wanying Xing
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Jun Song
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Zhixia Sun
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
| | - Xingzhao Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, P. R. China
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Nef HM, Elsässer A, Möllmann H, Abdel-Hadi M, Bauer T, Brück M, Eggebrecht H, Ehrlich JR, Ferrari MW, Fichtlscherer S, Hink U, Hölschermann H, Kacapor R, Koeth O, Korboukov S, Lamparter S, Laspoulas AJ, Lehmann R, Liebetrau C, Plücker T, Pons-Kühnemann J, Schächinger V, Schieffer B, Schott P, Schulze M, Teupe C, Vasa-Nicotera M, Weber M, Weinbrenner C, Werner G, Hamm CW, Dörr O. Impact of the COVID-19 pandemic on cardiovascular mortality and catherization activity during the lockdown in central Germany: an observational study. Clin Res Cardiol 2020; 110:292-301. [PMID: 33219854 PMCID: PMC7680078 DOI: 10.1007/s00392-020-01780-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Aims During the COVID-19 pandemic, hospital admissions for cardiac care have declined. However, effects on mortality are unclear. Thus, we sought to evaluate the impact of the lockdown period in central Germany on overall and cardiovascular deaths. Simultaneously we looked at catheterization activities in the same region. Methods and results Data from 22 of 24 public health-authorities in central Germany were aggregated during the pandemic related lockdown period and compared to the same time period in 2019. Information on the total number of deaths and causes of death, including cardiovascular mortality, were collected. Additionally, we compared rates of hospitalization (n = 5178) for chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and out of hospital cardiac arrest (OHCA) in 26 hospitals in this area. Data on 5,984 deaths occurring between March 23, 2020 and April 26, 2020 were evaluated. In comparison to the reference non-pandemic period in 2019 (deaths: n = 5832), there was a non-significant increase in all-cause mortality of 2.6% [incidence rate ratio (IRR) 1.03, 95% confidence interval (CI) 0.99–1.06; p = 0.16]. Cardiovascular and cardiac mortality increased significantly by 7.6% (IRR 1.08, 95%-CI 1.01–1.14; p = 0.02) and by 11.8% (IRR 1.12, 95%-CI 1.05–1.19; p < 0.001), respectively. During the same period, our data revealed a drop in cardiac catherization procedures. Conclusion During the COVID-19-related lockdown a significant increase in cardiovascular mortality was observed in central Germany, whereas catherization activities were reduced. The mechanisms underlying both of these observations should be investigated further in order to better understand the effects of a pandemic-related lockdown and social-distancing restrictions on cardiovascular care and mortality. Graphic abstract ![]()
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Affiliation(s)
- Holger M Nef
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany. .,Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany.
| | | | - Helge Möllmann
- St.-Johannes-Hospital Klinik Für Innere Medizin I, Dortmund, Germany
| | | | - Timm Bauer
- Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Martin Brück
- Department of Cardiology, Lahn-Dill-Kliniken, Klinikum Wetzlar, Wetzlar, Germany
| | - Holger Eggebrecht
- Department of Cardiology, Agaplesion Frankfurter Diakonie Kliniken, Frankfurt, Germany
| | - Joachim R Ehrlich
- Department of Cardiology, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Markus W Ferrari
- Department of Cardiology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Stephan Fichtlscherer
- Department of Cardiology, Herz-Kreislauf-Zentrum Klinikum Hersfeld-Rotenburg, Rotenburg, Germany
| | - Ulrich Hink
- Department of Cardiology, Klinikum Frankfurt Höchst, Frankfurt am Main, Germany
| | | | - Rifat Kacapor
- Department of Cardiology, Kliniken Des Main-Taunus-Kreises, Bad Soden am Taunus, Germany
| | - Oliver Koeth
- Department of Cardiology, GPR Gesundheits- Und Pflegezentrum Rüsselsheim, Rüsselsheim, Germany
| | | | - Steffen Lamparter
- Department of Cardiology, Diakonie-Krankenhaus Wehrda, Marburg, Germany
| | - Alexander J Laspoulas
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
| | - Ralf Lehmann
- Department of Cardiology, Asklepios Kliniken Langen, Langen, Germany
| | | | - Tobias Plücker
- Department of Cardiology, Eichhof-Stiftung Lauterbach, Lauterbach, Germany
| | - Jörn Pons-Kühnemann
- Justus Liebig University Giessen, Medical Statistics, Institute of Medical Informatics, Giessen, Germany
| | | | - Bernhard Schieffer
- Department of Internal Medicine/Cardiology and Angiology, University Hospital of Marburg, Marburg, Germany
| | - Peter Schott
- Department of Cardiology, Klinikum Werra Meissner GmbH, Eschwege, Germany
| | - Matthias Schulze
- Department of Cardiology, Asklepios Schwalm-Eder-Kliniken, Schwalmstadt, Germany
| | - Claudius Teupe
- Department of Cardiology, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany
| | | | - Michael Weber
- Department of Cardiology, Kreisklinik Groß-Umstadt, Groß-Umstadt, Germany
| | | | - Gerald Werner
- Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany.,Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Oliver Dörr
- Department of Cardiology, Justus Liebig University Giessen, University Hospital Giessen, Medical Clinic I, Klinikstrasse 33, 35392, Giessen, Germany
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Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study. Anatol J Cardiol 2020; 24:334-342. [PMID: 33122486 PMCID: PMC7724394 DOI: 10.14744/anatoljcardiol.2020.98607] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1). Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20–3.22) for NSTEMI, p=0.007; and 2.08 (1.38–3.13) for STEMI, p<0.001]. Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients’ fear of using healthcare services and mitigate the potential complications of AMI during the pandemic.
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