Myocardial infarction outcomes were significantly affected by the pandemic

During the COVID-19 pandemic, patients with symptoms of a myocardial infarction waited longer before seeking medical attention. This resulted not only in delayed revascularisations but also in worse acute outcomes and rehospitalisation due to heart failure (HF) after 6 months.

A retrospective, multicentre study with a cohort of patients from Lithuania aimed to assess whether the pandemic-provoked lockdowns affected the use of emergency healthcare in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI [1]. Evaluated were COVID-19 negative patients treated for STEMI or non-STEMI between 11 March and 20 April 2020 and during the same period in 2019. “In total, we enrolled 269 individuals; 107 individuals or about 40% presented in 2020, during the pandemic, and 162 individuals or about 60% presented in 2019, prior to the pandemic. They were well matched in terms of gender and other comorbidities,” explained Dr Ayman Haq (Baylor University Medical Center, TX, USA). The study measured in-hospital outcomes and major adverse cardiovascular events (MACE), as well as the individual components of MACE at 6 months.

“One of the most significant findings was how much longer patients were waiting to seek medical attention,” said Dr Haq. The overall pain-to-door time more than doubled from 385 minutes pre-pandemic to 858 minutes during the pandemic (P<0.0001). In the non-STEMI group, the difference was more pronounced with pain-to-door times of 558 and 2,021 minutes, respectively (P<0.0001). In the STEMI groups, the difference was also significant with pain-to-door times of 262 and 582 minutes, respectively (P=0.0003). Door-to-wire times were comparable for STEMI patients in 2019 and 2020, but numerically prolonged in 2020 for non-STEMI.

Also, the overall initial troponin I values were worse in 2020, with 7.8 mg/L versus 4.5 mg/L before the pandemic. Furthermore, post-interventional left ventricular ejection fraction was decreased during the pandemic. Overall, the incidence of MACE at 6 months was greater in 2020 (30.8% vs 13.6%; P=0.0006). This difference was again more pronounced in the non-STEMI group. “On examining the individual components of MACE, we saw that there were no statistical significances in the rates of stroke, non-fatal myocardial infarction, cardiovascular death, or target vessel revascularisation at 6 months. However, rates of hospitalisation for decompensated heart failure had increased dramatically,” stated Dr Haq. Hospitalisation for decompensated heart failure was identified as a major driver of the rise in MACE events in 2020 by the researchers. For example, in patients with non-STEMI, a 20-fold increase of decompensated heart failure was observed during the pandemic (1.3% vs 30%; P<0.0001).

Causality for these findings cannot be provided by the present study, but Dr Haq suggested that it is nonetheless important to emphasise that individuals should seek emergency medical attention during lockdowns and not delay or postpone care.

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   1. Aldujeli A, et al. Association between delayed revascularization during the COVID-19 pandemic and rates of post myocardial infarction heart failure hospitalisations. Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.

 

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Posted on 19 August 202120 August 2021