Analysis of the Prognosis Outcomes and Treatment Delay Among ST-Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19

Kwak, David Samuel; Park, Joonbum

doi:10.34172/ijhpm.2024.8207

Analysis of the Prognosis Outcomes and Treatment Delay Among ST-Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19

Document Type : Original Article

Authors

David Samuel Kwak ¹

Joonbum Park ²

¹ Department of Family Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

² Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

10.34172/ijhpm.2024.8207

Abstract

Background
During COVID-19 pandemic, the emergency department (ED) was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period.

Methods
This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center’s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality.

Results
Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms.

Conclusion
In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.

Keywords

Emergency Service

COVID-19

Patient Safety

Myocardial Infarction

Isolation

Korea

Subjects

COVID-19

Weiss EA, Ngo J, Gilbert GH, Quinn JV. Drive-through medicine: a novel proposal for rapid evaluation of patients during an influenza pandemic. Ann Emerg Med. 2010;55(3):268-273. doi:1016/j.annemergmed.2009.11.025
Lee J. Better understanding on MERS corona virus outbreak in Korea. J Korean Med Sci. 2015;30(7):835-836. doi:3346/jkms.2015.30.7.835
Long B, Carius BM, Chavez S, et al. Clinical update on COVID-19 for the emergency clinician: presentation and evaluation. Am J Emerg Med. 2022;54:46-57. doi:1016/j.ajem.2022.01.028
Heinert SW, Riggs R, Prendergast H. Emergency department management of hypertension in the context of COVID-19. Curr Hypertens Rep. 2022;24(2):37-43. doi:1007/s11906-022-01169-6
Frontera WR, Latimer MR, de Jesús K, Pabón A, González J, Conde JG. Effect of the COVID-19 pandemic on musculoskeletal care in the emergency room. Disaster Med Public Health Prep. 2022;17:e310. doi:1017/dmp.2022.276
Milovančev A, Miljković T, Petrović M, et al. Impact of the COVID-19 pandemic on cardiology emergency department visits. Int Heart J. 2022;63(4):749-754. doi:1536/ihj.21-750
Hohl CM, Rosychuk RJ, Hau JP, et al. Treatments, resource utilization, and outcomes of COVID-19 patients presenting to emergency departments across pandemic waves: an observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). CJEM. 2022;24(4):397-407. doi:1007/s43678-022-00275-3
Gualano MR, Sinigaglia T, Lo Moro G, et al. The burden of burnout among healthcare professionals of intensive care units and emergency departments during the COVID-19 pandemic: a systematic review. Int J Environ Res Public Health. 2021;18(15):8172. doi:3390/ijerph18158172
De Filippo O, D'Ascenzo F, Angelini F, et al. Reduced rate of hospital admissions for ACS during COVID-19 outbreak in Northern Italy. N Engl J Med. 2020;383(1):88-89. doi:1056/NEJMc2009166
Solomon MD, McNulty EJ, Rana JS, et al. The COVID-19 pandemic and the incidence of acute myocardial infarction. N Engl J Med. 2020;383(7):691-693. doi:1056/NEJMc2015630
Mann E, Swedien D, Hansen J, et al. Reduction in emergency department presentations in a regional health system during the COVID-19 pandemic. West J Emerg Med. 2021;22(4):842-850. doi:5811/westjem.2020.10.49759
Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where are all the patients? Addressing COVID-19 fear to encourage sick patients to seek emergency care. NEJM Catal Innov Care Deliv. 2020;1(3). doi:1056/cat.20.0193
Chaabane S, Doraiswamy S, Chaabna K, Mamtani R, Cheema S. The impact of COVID-19 school closure on child and adolescent health: a rapid systematic review. Children (Basel). 2021;8(5):415. doi:3390/children8050415
Basis F, Zeidani H, Hussein K, Hareli S. Drastic reduction inpatient visits to the emergency department in a hospital in Israel during the COVID-19 outbreak, compared to the H1N1 2009. Int J Health Policy Manag. 2022;11(4):429-433. doi:34172/ijhpm.2020.151
Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic. J Am Coll Cardiol. 2020;75(22):2871-2872. doi:1016/j.jacc.2020.04.011
da Cunha G, Cerci RJ, Silvestre OM, Cavalcanti AM, Nadruz W, Fernandes-Silva MM. Sex- and age-related impact of the COVID-19 pandemic on emergency department visits for chest pain in Curitiba, Brazil. J Emerg Med. 2022;63(5):656-660. doi:1016/j.jemermed.2022.08.003
Montagnon R, Rouffilange L, Agard G, Benner P, Cazes N, Renard A. Impact of the COVID-19 pandemic on emergency department use: focus on patients requiring urgent revascularization. J Emerg Med. 2021;60(2):229-236. doi:1016/j.jemermed.2020.09.042
Terkelsen CJ, Christiansen EH, Sørensen JT, et al. Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time. Heart. 2009;95(5):362-369. doi:1136/hrt.2007.139493
Abouelmagd K, Tayel H, Atta A, Ladwiniec A, Ibrahim M. Early versus delayed complete revascularisation in patients presenting with ST-segment elevation myocardial infarction and multivessel disease: a systematic review and meta-analysis of randomised controlled trials. Open Heart. 2022;9(1):e001975. doi:1136/openhrt-2022-001975
Park J, Choi KH, Lee JM, et al. Prognostic implications of door-to-balloon time and onset-to-door time on mortality in patients with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention. J Am Heart Assoc. 2019;8(9):e012188. doi:1161/jaha.119.012188
Karkabi B, Meir G, Zafrir B, et al. Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Eur Heart J Qual Care Clin Outcomes. 2021;7(4):422-426. doi:1093/ehjqcco/qcaa037
Ma J, Zhou S, Li N, et al. Quality of healthcare and admission rates for acute cardiac events during COVID-19 pandemic: a retrospective cohort study on ST-segment-elevation myocardial infarction in China. BMJ Open. 2022;12(11):e059720. doi:1136/bmjopen-2021-059720
De Rosa S, Spaccarotella C, Basso C, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41(22):2083-2088. doi:1093/eurheartj/ehaa409
Daoulah A, Hersi AS, Al-Faifi SM, et al. STEMI and COVID-19 pandemic in Saudi Arabia. Curr Probl Cardiol. 2021;46(3):100656. doi:1016/j.cpcardiol.2020.100656
Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-389. doi:1016/s0140-6736(20)31356-8
Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med. 2022;57:91-97. doi:1016/j.ajem.2022.04.033
Kiss P, Carcel C, Hockham C, Peters SA. The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review. Eur Heart J Qual Care Clin Outcomes. 2021;7(1):18-27. doi:1093/ehjqcco/qcaa084
Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369(10):901-909. doi:1056/NEJMoa1208200
Pedersen S, Galatius S, Mogelvang R, et al. Long-term prognosis in an ST-segment elevation myocardial infarction population treated with routine primary percutaneous coronary intervention: from clinical trial to real-life experience. Circ Cardiovasc Interv. 2009;2(5):392-400. doi:1161/circinterventions.108.845636
Terkelsen CJ, Jensen LO, Tilsted HH, et al. Health care system delay and heart failure in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: follow-up of population-based medical registry data. Ann Intern Med. 2011;155(6):361-367. doi:7326/0003-4819-155-6-201109200-00004
Baldi E, Sechi GM, Mare C, et al. Out-of-hospital cardiac arrest during the COVID-19 outbreak in Italy. N Engl J Med. 2020;383(5):496-498. doi:1056/NEJMc2010418