Background

Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown.

Aim

To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019.

Methods

In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction.

Results

A total of 6306 patients were included. During the pandemic peak, a 13.9 ± 6.6% (P = 0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150−705] vs 245 [140−646] min; P = 0.013), driven by the increase in time from symptom onset to first medical contact (121 [60−360] vs 150 [62−420] min; P = 0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P = 0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P = 0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock.

Conclusions

During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.

中文翻译：

---

ST 段抬高型心肌梗死：法国 COVID-19 大流行期间的管理及其与预后的关联

背景

护理系统在控制 COVID-19 大流行的进展方面受到挑战。这是否与法国 ST 段抬高型心肌梗死 (STEMI) 患者的再灌注延迟和预后更差有关尚不清楚。

目的

比较法国 COVID-19 大流行的第一个高峰与 2019 年同期的 STEMI 入院率、治疗延误和结果。

方法

在这项全国性的法国调查中，分析了 2020 年 3 月 1 日至 5 月 31 日以及 2019 年 3 月 1 日至 5 月 31 日期间转诊进行紧急血运重建的 65 个中心的连续 STEMI 患者的数据。主要结局是院内死亡或急性心肌梗死的非致命性机械并发症的复合结局。

结果

共纳入 6306 名患者。在大流行高峰期间，观察到每周 STEMI 入院人数减少了 13.9  ±  6.6% ( P  = 0.003)。 症状发作和经皮冠状动脉介入治疗之间的延迟在 2020 年比 2019 年更长（270 [四分位间距 150-705] 对 245 [140-646] 分钟；P  =  0.013），这是由于从症状发作到第一次医疗接触的时间增加（121 [60−360] 与 150 [62−420] 分钟；P  =  0.002）。在 2020 年期间，观察到更多的机械并发症（0.9% 对 1.7%；P  =  0.029），导致主要结果存在显着差异（2019 年 112 名患者 [5.6%] 对 2020 年 129 名 [7.6%]；P  =  0.018）。在经口气管插管、院内心脏骤停、室性心律失常和心源性休克的发生率方面未观察到显着差异。

结论

在法国 COVID-19 大流行的第一个高峰期间，STEMI 入院人数减少，与更长的缺血时间相关，这完全是由于患者相关延误的增加和机械并发症的增加。这些发现表明需要鼓励人们在出现症状时寻求医疗帮助。