Delaying medical care to patients with acute myocardial infarction during COVID‑19 pandemic

Prokhorov K. V., Koriagina N. A., Spasenkov G. N., Koriagin V. S., Avdeev A. V., Marchenko D. D.

The 2019 novel coronavirus infection (COVID-19) pandemic has had a major impact on patient behavior as well as on the delivery of health care. Particularly vulnerable were older people of working age who stayed at home to avoid contracting the virus, and it remains unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if there are delays in the provision of medical services for AMI during the COVID-19 pandemic, compared to the same period a year earlier. Methods. In this single-center retrospective study, we evaluated the rates of patients admitted with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) during the COVID-19 pandemic (10/01/2020-11/30/2020) compared to with patients admitted in the same period a year earlier. Results: 147 patients were referred in 2020 and 225 in 2019 with AMI to the regional vascular center. There were 87 and 147 patients with STEMI during the pandemic and before the pandemic, respectively. The average delivery time from pain to door during the pandemic was significantly longer than in the pre-pandemic period (612 (255, 1450) vs 341 (141, 705) min, p = 0.02). There were 40 (46%) and 33 (22%) patients. who came in 12 hours after the onset of pain in the pandemic and pre-pandemic eras (p = 0.011). There was no significant delay in door-to-reperfusion time (p = 0.98). Differences were found in hospital deaths in STEMI patients. There were 40 and 78 NSTEMI patients during the pandemic and before the pandemic, respectively. In patients, the mean delivery time from pain to the door was significantly longer during the pandemic compared to the pre-pandemic period (1880 (880, 4700) vs 604 (370, 934) min, p <0.0001). During the pandemic, there was a significant delay in door-to-door reperfusion time, the average time was 330 (179, 602) versus 192 (90, 328) min (p = 0.0374). According to the analysis results, 18 (45%) in 2020 and 19 (24%) in 2019 patients presented 12 hours after the onset of pain in the pandemic and pre-pandemic eras, respectively (p = 0.001). Conclusions: Patients waited significantly longer during the pandemic to seek medical attention. Anti-infective protocols specific during pandemia may delay revascularization in NSTEMI patients. These results led to more than a threefold increase in the time from the onset of pain to revascularization, which increases the risk of future complications.

Keywords:COVID-19; SARS-CoV-2; Delayed revascularization; fear of COVID-19; Acute myocardial infarction.