COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group.
Aged
Ambulances
/ organization & administration
COVID-19
Coronavirus Infections
/ diagnosis
Critical Pathways
/ organization & administration
Databases, Factual
Delivery of Health Care, Integrated
/ organization & administration
Female
Hospital Mortality
Humans
Length of Stay
London
/ epidemiology
Male
Middle Aged
Outcome and Process Assessment, Health Care
/ organization & administration
Pandemics
Patient Admission
Patient Safety
Percutaneous Coronary Intervention
/ adverse effects
Pneumonia, Viral
/ diagnosis
Retrospective Studies
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction
/ diagnosis
Thrombosis
/ mortality
Time Factors
Time-to-Treatment
/ organization & administration
Treatment Outcome
acute coronary syndrome
chest pain
myocardial infarction
percutaneous coronary intervention
Journal
Open heart
ISSN: 2053-3624
Titre abrégé: Open Heart
Pays: England
ID NLM: 101631219
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
28
08
2020
revised:
11
09
2020
accepted:
21
09
2020
entrez:
27
10
2020
pubmed:
28
10
2020
medline:
5
11
2020
Statut:
ppublish
Résumé
To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.
Identifiants
pubmed: 33106441
pii: openhrt-2020-001432
doi: 10.1136/openhrt-2020-001432
pmc: PMC7592245
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 203145Z/16/Z
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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