Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic
Patient response, treatments, and mortality for acute myocardial infarction during the COVID-19 pandemic
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DOI：
10.1093/ehjqcco/qcaa062
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发表时间：
2021-07-01
影响因子：
5.2
通讯作者：
Gale, Chris P.
中科院分区：
文献类型：
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作者：
Wu, Jianhua;Mamas, Mamas;Gale, Chris P.
COVID-19可能影响住院急性心肌梗死（AMI）的护理和结局。我们的目的是确定COVID-19大流行是否改变了患者的反应，医院治疗和AMI的死亡率。方法和结果通过2019年1月1日至2020年5月22日期间心肌缺血国家审计项目的实时喂养，将英格兰99家医院的入院分类为非ST段抬高型心肌梗死（NSTEMI）或STEMI。时间序列图估计使用7天简单移动平均，调整季节性。自2020年3月23日（英国封锁）起，NSTEMI的每日住院中位数[69至35;发病率风险比（IRR）0.51，95%置信区间（CI）0.47-0.54]比STEMI（35至25; IRR 0.74，95% CI 0.69-0.80）下降更多，于2020年4月19日达到最低点。在锁定期间，患者更年轻（平均年龄68.7 vs. 66.9岁），糖尿病发生率更低（24.6% vs. 28.1%），或患有脑血管疾病（7.0% vs. 8.6%）。ST段抬高型心肌梗死更常接受直接经皮冠状动脉介入治疗（81.8%对78.8%），溶栓可忽略不计（0.5% vs. 0.3%），NSTEMI的中位入院至冠状动脉造影持续时间缩短（26.2 vs. 64.0 h），中位住院时间缩短（4 ~ 2天），二级预防药物治疗处方保持不变（均> 94.7%）。NSTEMI患者30天死亡率增加[从5.4%增加到7.5%;比值比（OR）1.41，95%CI 1.08-1.80]，但STEMI患者30天死亡率下降[从10.2%增加到7.7%; OR 0.73，95%CI 0.54-0.97]。那些到医院就诊的人更年轻，合并症更少，对于NSTEMI，30天死亡率更高。
Aims COVID-19 might have affected the care and outcomes of hospitalized acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment, and mortality from AMI.Methods and results Admission was classified as non-ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1 January 2019 and 22 May 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23 March 2020 (UK lockdown), median daily hospitalizations decreased more for NSTEMI [69 to 35; incidence risk ratios (IRR) 0.51, 95% confidence interval (CI) 0.47-0.54] than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19 April 2020. During lockdown, patients were younger (mean age 68.7 vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%), or had cerebrovascular disease (7.0% vs. 8.6%). ST-elevation myocardial infarction more frequently received primary percutaneous coronary intervention (81.8% vs. 78.8%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 h), median duration of hospitalization decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each > 94.7%). Mortality at 30 days increased for NSTEMI [from 5.4% to 7.5%; odds ratio (OR) 1.41, 95% CI 1.08-1.80], but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97).Conclusion During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less comorbid and, for NSTEMI, had higher 30-day mortality.