ST-segment elevation myocardial infarction: Management and association with prognosis during the COVID-19 pandemic in France.

Bonnet, Guillaume; Panagides, Vassili; Becker, Mathieu; Rivière, Nicolas; Yvorel, Cédric; Deney, Antoine; Lattuca, Benoit; Duband, Benjamin; Moussa, Karim; Juenin, Léa; Pamart, Thibault; Semaan, Carl; Uhry, Sabrina; Noirclerc, Nathalie; Vincent, Flavien; Vignac, Maxime; Palermo, Vincenzo; Martin, Anne Sophie; Zeitouni, Michel; Van Belle, Eric; Tirouvanziam, Ashok; Manchuelle, Aurélie; Chamandi, Chekrallah; Kerneis, Mathieu; Boukantar, Madjid; Belle, Loïc; De Poli, Fabien; Angoulvant, Denis; Meneveau, Nicolas; Robin, Marie; Pansieri, Michel; Bonello, Laurent; Motreff, Pascal; Bouisset, Frédéric; Isaaz, Karl; Cetran, Laura; Khalife, Khalifé; Lesizza, Pierluigi; Adjedj, Julien; Benamer, Hakim; Cayla, Guillaume

BACKGROUND Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.