Primary percutaneous coronary intervention (PPCI) procedures for ST-segment elevation myocardial infarction (STEMI) significantly decreased during the coronavirus disease 2019 (COVID-19) pandemic, particularly in patients with hypertension, according to a study published in the Journal of the American College of Cardiology.
In this retrospective registry review, the data of 6609 patients with STEMI who underwent mechanical reperfusion at 77 centers across 18 countries were examined. This cohort included 3484 and 2811 patients (median age for both, 60 years) who underwent STEMI in 2019 and 2020, respectively. The study’s primary outcomes included incidence of PPCI, delayed treatment, and in-hospital mortality.
There was a significant reduction in PPCI during the 2020 pandemic compared with 2019 (incidence rate ratio [IRR], 0.811; 95% CI, 0.78-0.84; P <.0001). Heterogeneity across centers was not associated with incidence of COVID-19-related death.
The reduction in STEMI was significant only when comparing patients with vs without hypertension (IRR, 0.857; 95% CI, 0.812-0.903; P <.0001 vs IRR, 0.774; 95% CI, 0.735-0.812; P <.0001, respectively). There was also a significant increase from 2019 to 2020 in door-to-balloon times (P =.003) and total ischemia times (P =.001), which the investigators suggested may have contributed to higher mortality rates during the COVID-19 pandemic (2019 vs 2020: 6.8% vs 4.9%, respectively; odds ratio, 1.41; 95% CI, 1.15-1.71; P <.001).
Limitations of the study include its retrospective design as well as the likelihood of missing data due to the emergency associated with the pandemic.
The researchers recommended that health authorities and “scientific societies take vigorous action to prevent patients from neglecting characteristic symptoms of an acute myocardial infarction, especially among patients who suffer from hypertension.”
De Luca G, Verdoia M, Cercek M, et al. Impact of COVID-19 pandemic on mechanical reperfusion for patients with STEMI. J Am Coll Cardiol. 2020;76(20):2321-2330. doi:10.1016/j.jacc.2020.09.546s