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Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data

INTRODUCTION: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case...

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Autores principales: Azul Freitas, André, Baptista, Rui, Gonçalves, Valdirene, Ferreira, Cátia, Milner, James, Lourenço, Carolina, Costa, Susana, Franco, Fátima, Monteiro, Sílvia, Gonçalves, Francisco, Gonçalves, Lino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278193/
https://www.ncbi.nlm.nih.gov/pubmed/34274091
http://dx.doi.org/10.1016/j.repce.2021.07.014
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author Azul Freitas, André
Baptista, Rui
Gonçalves, Valdirene
Ferreira, Cátia
Milner, James
Lourenço, Carolina
Costa, Susana
Franco, Fátima
Monteiro, Sílvia
Gonçalves, Francisco
Gonçalves, Lino
author_facet Azul Freitas, André
Baptista, Rui
Gonçalves, Valdirene
Ferreira, Cátia
Milner, James
Lourenço, Carolina
Costa, Susana
Franco, Fátima
Monteiro, Sílvia
Gonçalves, Francisco
Gonçalves, Lino
author_sort Azul Freitas, André
collection PubMed
description INTRODUCTION: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS: We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS: A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION: Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.
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spelling pubmed-82781932021-07-14 Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data Azul Freitas, André Baptista, Rui Gonçalves, Valdirene Ferreira, Cátia Milner, James Lourenço, Carolina Costa, Susana Franco, Fátima Monteiro, Sílvia Gonçalves, Francisco Gonçalves, Lino Rev Port Cardiol (Engl Ed) Original Article INTRODUCTION: Coronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. METHODS: We conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. RESULTS: A total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). CONCLUSION: Despite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic. Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. 2021-07 2021-07-14 /pmc/articles/PMC8278193/ /pubmed/34274091 http://dx.doi.org/10.1016/j.repce.2021.07.014 Text en © 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Azul Freitas, André
Baptista, Rui
Gonçalves, Valdirene
Ferreira, Cátia
Milner, James
Lourenço, Carolina
Costa, Susana
Franco, Fátima
Monteiro, Sílvia
Gonçalves, Francisco
Gonçalves, Lino
Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title_full Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title_fullStr Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title_full_unstemmed Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title_short Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data
title_sort impact of sars-cov-2 pandemic on st-elevation myocardial infarction admissions and outcomes in a portuguese primary percutaneous coronary intervention center: preliminary data
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278193/
https://www.ncbi.nlm.nih.gov/pubmed/34274091
http://dx.doi.org/10.1016/j.repce.2021.07.014
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