Aims 

The aim of this study was to report the prevalence, clinical features and outcomes of patients with ST-elevation myocardial infarction (STEMI) hospitalized during the Corona-Virus Disease 2019 (COVID-19) outbreak compared with those admitted in a previous equivalent period.

Methods and results 

Eighty-five patients admitted for STEMI at a high-volume Italian centre were included. Patients hospitalized during the COVID-19 outbreak (21 February–10 April 2020) (40%) were compared with those admitted in pre-COVID-19 period (3 January–20 February 2020) (60%). A 43% reduction in STEMI admissions was observed during the COVID-19 outbreak compared with the previous period. Time from symptom onset to first medical contact (FMC) and time from FMC to primary percutaneous coronary intervention (PPCI) were longer in patients admitted during the COVID-19 period compared with before [148 (79–781) versus 130 (30–185) min; P = 0.018, and 75 (59–148)] versus 45 (30–70) min; P < 0.001]. High-sensitive troponin T levels on admission were also higher. In-hospital mortality was 12% in the COVID-19 phase versus 6% in the pre-COVID-19 period. Incidence of the composite end-point, including free-wall rupture, severe left ventricular dysfunction, left ventricular aneurysm, severe mitral regurgitation and pericardial effusion, was higher during the COVID-19 than the pre-COVID-19 period (19.6 versus 41.2%; P = 0.030; odds ratio = 2.87; 95% confidence interval 1.09–7.58).

Conclusion 

The COVID-19 pandemic had a significant impact on the STEMI care system reducing hospital admissions and prolonging revascularization time. This translated into a worse patient prognosis due to more STEMI complications.

中文翻译：

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COVID-2019爆发对ST抬高型心肌梗死的患病率，临床表现和预后的影响

目的 

这项研究的目的是报告与2019年同期在科罗纳病毒病（COVID-19）爆发期间住院的ST抬高型心肌梗死（STEMI）患者的患病率，临床特征和结果相比。

方法与结果 

包括在意大利一个大容量中心接受STEMI治疗的八十五名患者。将在COVID-19爆发期间（2020年2月21日至2020年4月10日）住院的患者（40％）与在COVID-19之前的时期（2020年1月3日至2月20日）住院的患者（60％）进行了比较。与上一时期相比，在COVID-19爆发期间观察到STEMI入院人数减少了43％。在COVID-19期间入院的患者从症状发作到首次就医（FMC）的时间以及从FMC到初次经皮冠状动脉介入治疗（PPCI）的时间比之前[148（79-781）和130（30-185） ）分钟；P = 0.018，75（59-148）分钟对45（30-70）分钟；P<0.001]。入院时高敏感性肌钙蛋白T水平也更高。在COVID-19阶段，院内死亡率为12％，而在COVID-19之前为6％。复合终点的发生率，包括游离壁破裂，严重的左心室功能障碍，左心室动脉瘤，严重的二尖瓣反流和心包积液，在COVID-19期间比COVID-19之前的时期要高（19.6比41.2％ ；P = 0.030；优势比= 2.87； 95％置信区间1.09-7.58）。

结论 

COVID-19大流行对STEMI护理系统产生了重大影响，减少了住院人数并延长了血运重建时间。由于更多的STEMI并发症，这转化为更差的患者预后。