Original Investigation
Management and Outcomes of Patients With STEMI During the COVID-19 Pandemic in China

https://doi.org/10.1016/j.jacc.2020.06.039Get rights and content
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Abstract

Background

ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients.

Objectives

This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol on the treatment and prognosis of STEMI patients in China.

Methods

Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center’s modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients.

Results

The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center’s modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable.

Conclusions

There were reductions in STEMI patients’ access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China.

Key Words

chest pain center
COVID-19
primary percutaneous coronary intervention
ST-segment elevation myocardial infarction
thrombolysis

Abbreviations and Acronyms

CCPC
China Chest Pain Center
CCPCEC
China Chest Pain Center Executive Committee
CI
confidence interval
COVID-19
coronavirus disease-2019
CPC
Chest Pain Center
FMC-to-N
time from first medical contact to needle (the beginning of thrombolysis)
FMC-to-W
time from first medical contact to wire crossing
IQR
interquartile range
OR
odds ratio
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction
S-to-FMC
time from symptom onset to first medical contact

Cited by (0)

This study is supported by Ministry of Science and Technology of the People’s Republic of China (2016YFC1301201). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Drs. Dingcheng Xiang and Xin Xiang contributed equally to this work.