Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study

BACKGROUND: Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have affected management of STEMI. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system. METHODS: Four hundred ninety-four patients with STEMI were grouped into prelockdown, lockdown, and reopening cohorts. Clinical, temporal, and outcome data were collected and compared among groups for both urban and rural patients, receiving primary percutaneous coronary intervention (PCI) and pharmacoinvasive revascularization, respectively. Data were compared with a 10-year historical comparator. RESULTS: During prelockdown, there were 238 cases vs 193 in lockdown: a 19.0% reduction in volume. When lockdown was compared with the median caseload from a 10-year historical cohort, a 19.8% reduction was observed. For patients treated with primary PCI during lockdown, median symptom-to-balloon time increased by 44 minutes (217 interquartile range [IQR: 157-387] vs 261 [IQR: 160-659] minutes; P = 0.03); driven by an increase in median symptom-to-door time of 41 minutes (136 [IQR: 80-267] vs 177 [IQR: 90-569] minutes; P < 0.01). Only patients transferred from non-PCI facilities demonstrated an increase in door-to-reperfusion time (116 [IQR: 93-150] vs 139 [IQR: 100-199] minutes; P < 0.01). More patients had left-ventricular dysfunction during the lockdown (35% vs 44%; P = 0.04), but there was no difference in mortality. CONCLUSIONS: During the COVID-19 lockdown, fewer patients presented with STEMI. Time-to-reperfusion was significantly prolonged and appeared driven predominantly by patient level and transfer delays. Public education and systems-level changes will be integral to STEMI care during the second wave of COVID-19.