Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction.
Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction.
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DOI：
10.3346/jkms.2022.37.e167
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发表时间：
2022-05-30
影响因子：
4.5
通讯作者：
Yongkeun, Cho
中科院分区：
文献类型：
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作者：
Hyohun, Choi;Hoon, Lee Jang;Kyoon, Park Hyuk;Eunkyu, Lee;Seop, Kim Myeong;Jeong, Kim Hyeon;Eun, Park Bo;Nyun, Kim Hong;Namkyun, Kim;Yong, Jang Se;Hwan, Bae Myung;Heon, Yang Dong;Sik, Park Hun;Yongkeun, Cho
众所周知，在2019冠状病毒病（COVID-19）期间，对传染的恐惧会造成时间延迟，从而影响急性心肌梗死（AMI）患者的死亡率。但是，国内尚未全面调查新冠肺炎大流行时期与大流行前时期st段抬高型心肌梗死（STEMI）或非STEMI患者的时间延迟和临床结局的差异。本研究的目的是调查与前几年同期相比，COVID-19大流行对STEMI或非STEMI患者的时间延迟和临床结果的影响。本研究分析了在2019冠状病毒病大流行期间（2020年2月1日至4月30日）和大流行前时期（2017年、2018年和2019年2月1日至4月30日）接受冠状动脉造影的598例STEMI患者（n = 195）或非STEMI患者（n = 403）。主要结局为时间延迟、心脏骤停和院内死亡的发生率。与大流行前相比，大流行期间因AMI住院的患者人数减少了13.5%。在STEMI患者中，与大流行前相比，大流行期间门到球囊时间往往更长（55.7±12.6分钟比60.8±13.0分钟，P = 0.08）。大流行前和大流行时期的心脏骤停（15.6%比10.4%,P = 0.397）和住院死亡率（15.6%比10.4%,P = 0.397）无显著差异。非stemi患者从症状到就诊时间明显延长（310.0±346.2分钟vs 511.5±635.7分钟，P = 0.038），心脏骤停发生率（0.9% vs. 3.5%, P = 0.017）和住院死亡率（0.3% vs. 2.3%, P = 0.045）显著高于大流行前。在药物中，血管紧张素转换酶抑制剂/血管紧张素2型受体阻滞剂（ACE-I/ARBs）在大流行期间在STEMI（64.6%对45.8%,P = 0.021）和非STEMI（67.8%对57.0%,P = 0.061）中使用不足。在2019冠状病毒病大流行期间，AMI住院人数、时间延迟和ACE-I/ arb治疗AMI使用不足的情况大幅减少，这可能与韩国的高死亡率密切相关。
It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior. A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death. There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic. During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.
DOI：
10.3390/ijerph18189847
发表时间：
2021-09-18
影响因子：
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作者：
Marotta M;Gorini F;Parlanti A;Chatzianagnostou K;Mazzone A;Berti S;Vassalle C
通讯作者：
Vassalle C