Impact of COVID-19 on ST-segment elevation myocardial infarction care. The Spanish experience

Rodríguez-Leor, Oriol; Cid-Álvarez, Belén; Pérez de Prado, Armando; Rossello, Xavier; Ojeda, Soledad; Serrador, Ana; López-Palop, Ramón; Martín-Moreiras, Javier; Rumoroso, José Ramón; Cequier, Ángel; Ibáñez, Borja; Cruz-González, Ignacio; Romaguera, Rafael; Moreno, Raúl; Villa, Manuel; Ruíz-Salmerón, Rafael; Molano, Francisco; Sánchez, Carlos; Muñoz-García, Erika; Íñigo, Luís; Herrador, Juan; Gómez-Menchero, Antonio; Gómez-Menchero, Antonio; Caballero, Juan; Ojeda, Soledad; Cárdenas, Mérida; Gheorghe, Livia; Oneto, Jesús; Morales, Francisco; Valencia, Félix; Ruíz, José Ramón; Diarte, José Antonio; Avanzas, Pablo; Rondán, Juan; Peral, Vicente; Pernasetti, Lucía Vera; Hernández, Julio; Bosa, Francisco; Lorenzo, Pedro Luís Martín; Jiménez, Francisco; Hernández, José M de la Torre; Jiménez-Mazuecos, Jesús; Lozano, Fernando; Moreu, José; Novo, Enrique; Robles, Javier; Moreiras, Javier Martín; Fernández-Vázquez, Felipe; Amat-Santos, Ignacio J.; Gómez-Hospital, Joan Antoni; García-Picart, Joan; Blanco, Bruno García del; Regueiro, Ander; Carrillo-Suárez, Xavier; Tizón, Helena; Mohandes, Mohsen; Casanova, Juan; Agudelo-Montañez, Víctor; Muñoz, Juan Francisco; Franco, Juan; del Castillo, Roberto; Salinas, Pablo; Elizaga, Jaime; Sarnago, Fernando; Jiménez-Valero, Santiago; Rivero, Fernando; Oteo, Juan Francisco; Alegría-Barrero, Eduardo; Sánchez-Recalde, Ángel; Ruíz, Valeriano; Pinar, Eduardo; Pinar, Eduardo; Planas, Ana; Ledesma, Bernabé López; Berenguer, Alberto; Fernández-Cisnal, Agustín; Aguar, Pablo; Pomar, Francisco; Jerez, Miguel; Torres, Francisco; García, Ricardo; Frutos, Araceli; Nodar, Juan Miguel Ruíz; García, Koldobika; Sáez, Roberto; Torres, Alfonso; Tellería, Miren; Sadaba, Mario; Mínguez, José Ramón López; Merchán, Juan Carlos Rama; Portales, Javier; Trillo, Ramiro; Aldama, Guillermo; Fernández, Saleta; Santás, Melisa; Pérez, María Pilar Portero

INTRODUCTION AND OBJECTIVES: The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. METHODS: Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. RESULTS: Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P < .001) but showed no differences in the time from first medical contact to reperfusion. In-hospital mortality was higher during COVID-19 (7.5% vs 5.1%; unadjusted OR, 1.50; 95%CI, 1.07-2.11; P < .001); this association remained after adjustment for confounders (risk-adjusted OR, 1.88; 95%CI, 1.12-3.14; P = .017). In the 2020 cohort, there was a 6.3% incidence of confirmed SARS-CoV-2 infection during hospitalization. CONCLUSIONS: The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.