Impacto de la COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia española

INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter,...

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Detalles Bibliográficos
Autores principales: Rodríguez-Leor, Oriol, Cid-Álvarez, Belén, Pérez de Prado, Armando, Rossello, Xavier, Ojeda, Soledad, Serrador, Ana, López-Palop, Ramón, Martín-Moreiras, Javier, Rumoroso, José Ramón, Cequier, Ángel, Ibáñez, Borja, Cruz-González, Ignacio, Romaguera, Rafael, Moreno, Raúl, Villa, Manuel, Ruíz-Salmerón, Rafael, Molano, Francisco, Sánchez, Carlos, Muñoz-García, Erika, Íñigo, Luís, Herrador, Juan, Gómez-Menchero, Antonio, Caballero, Juan, Cárdenas, Mérida, Gheorghe, Livia, Oneto, Jesús, Morales, Francisco, Valencia, Félix, Ruíz, José Ramón, Diarte, José Antonio, Avanzas, Pablo, Rondán, Juan, Peral, Vicente, Pernasetti, Lucía Vera, Hernández, Julio, Bosa, Francisco, Lorenzo, Pedro Luís Martín, Jiménez, Francisco, Hernández, José M. de la Torre, Jiménez-Mazuecos, Jesús, Lozano, Fernando, Moreu, José, Novo, Enrique, Robles, Javier, Moreiras, Javier Martín, Fernández-Vázquez, Felipe, Amat-Santos, Ignacio J., Gómez-Hospital, Joan Antoni, García-Picart, Joan, Blanco, Bruno García del, Regueiro, Ander, Carrillo-Suárez, Xavier, Tizón, Helena, Mohandes, Mohsen, Casanova, Juan, Agudelo-Montañez, Víctor, Muñoz, Juan Francisco, Franco, Juan, del Castillo, Roberto, Salinas, Pablo, Elizaga, Jaime, Sarnago, Fernando, Jiménez-Valero, Santiago, Rivero, Fernando, Oteo, Juan Francisco, Alegría-Barrero, Eduardo, Sánchez-Recalde, Ángel, Ruíz, Valeriano, Pinar, Eduardo, Planas, Ana, Ledesma, Bernabé López, Berenguer, Alberto, Fernández-Cisnal, Agustín, Aguar, Pablo, Pomar, Francisco, Jerez, Miguel, Torres, Francisco, García, Ricardo, Frutos, Araceli, Nodar, Juan Miguel Ruíz, García, Koldobika, Sáez, Roberto, Torres, Alfonso, Tellería, Miren, Sadaba, Mario, Mínguez, José Ramón López, Merchán, Juan Carlos Rama, Portales, Javier, Trillo, Ramiro, Aldama, Guillermo, Fernández, Saleta, Santás, Melisa, Pérez, María Pilar Portero
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. 2020
Materias:
Artículo Original
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7546233/
https://www.ncbi.nlm.nih.gov/pubmed/33071427
http://dx.doi.org/10.1016/j.recesp.2020.07.033
Descripción
Sumario:INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

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