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Treatment times of acute STEMI have increased with COVID-19 pandemic

American Journal of Emergency Medicine
Reuters Health - 23/09/2020 - Times to treatment and mortality of acute ST-segment elevation myocardial infarction (STEMI) have increased since the onset of the COVID-19 pandemic, researchers in China report.

"The COVID-19 epidemic is a major global event that poses a huge challenge to the global medical system and even changes the previous treatment procedures and plans," Dr. Ming-Wei Wang of Affiliated Hospital of Hangzhou Normal University told Reuters Health by email. "We need to pay attention to the treatment of critically ill patients, because this requires a race against time to improve the prognosis."

Several studies have identified treatment delays of patients with STEMI since the beginning of the pandemic, with many attributing these delays to patient reluctance to go to the hospital and to protocols initiated to stem the spread of the virus.

Dr. Wang and colleagues developed a STEMI treatment process in an effort to prevent and control the epidemic while optimizing treatment. To provide a basis for assessing the effect of their protocol, they compared outcomes of STEMI patients during the COVID-19 pandemic (from late January to late April) with those of patients during the corresponding period in 2019.

The average time interval from symptom onset to first medical contact was significantly longer in 2020 than in 2019 (319.4 minutes vs. 261.5 minutes), as was the average door-to-balloon time (83.3 minutes vs. 61.1 minutes), the researchers report in the American Journal of Emergency Medicine.

The average catheter room activation time was also significantly greater for the 2020 patients than for the 2019 patients (24.2 minutes vs. 16.1 minutes).

The authors attribute the longer times to first medical contact to patients' fear of becoming infected with SARS-CoV-2, while the longer door-to-balloon times may be explained by COVID-19 screening of the patient and accompanying family members.

In the 2020 group of 24 patients, there were two deaths from cardiogenic shock and one death from malignant arrhythmia. Among the 29 patients in 2019, there was one death from posterior septal perforation and one from malignant arrhythmia.

The cumulative mortality was significantly higher in the 2020 group than in the 2019 group, the researchers say.

To address these deficiencies, the authors recommend education of the medical staff regarding the chest-pain treatment protocol and education of the public regarding the importance of early presentation; speeding the COVID-19 screening process; and shortening lung CT examination times to enable earlier intervention.

"We believe that by optimizing the above measures and procedures, the total treatment time of STEMI patients can be shortened, thereby improving their prognosis," Dr. Wang said.

Dr. Aditya Kapoor of Sanjay Gandhi Postgraduate Institute of Medical Sciences, in Lucknow, India, who recently addressed the impact of COVID-19 on the management of acute coronary syndrome (ACS) and STEMI, told Reuters Health by email, "Overall, the results are in keeping with what has also been observed in some previous studies. Resource and manpower allocation to COVID-19 treatment, lockdown restrictions, and patient apprehensions related to hospital visits all play an important role."]

"Developing telecardiology services to keep track of patients, closely following them, titrating their medicines, and offering them timely advice regarding impending hospital visit in case of onset of new symptoms are vital aspects of non-COVID-19 care," he said. "This will also ensure that patients maintain open communication channels with their doctors/nurses and shall not shy away from seeking timely help."

"We need more data from high-volume centers addressing these issues so that appropriate remedial measures can be taken," Dr. Kapoor said.

Dr. Saqib Masroor, chief of cardiothoracic surgery at the University of Toledo Medical Center, in Ohio, who recently described delays in medical care associated with the pandemic, said, "The most important message is to make telemedicine an integral part of medicine, not just emergency medicine but routine healthcare. These delays can be easily avoided if patients have access to expert advice over the Internet."

"Public awareness campaigns need to be initiated to allay the public's fears of catching COVID-19 and reiterate to them the signs and symptoms of stroke, heart attacks, and other serious life-threatening conditions," he told Reuters Health by email.

By Will Boggs MD

SOURCE: https://bit.ly/2EphfJt American Journal of Emergency Medicine, online September 16, 2020.

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