The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

Ayad, Sherif W.; Henein, Michael; Shenouda, Rafik R.

Background: Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on the in-hospital outcomes of ST-elevation myocardial infarction (STEMI) patients managed with PPCI. Methods: This observational retrospective study was conducted on consecutive STEMI patients who presented to International Cardiac Center (ICC) Hospital, Alexandria, Egypt between February 1 and October 31, 2020. A group of STEMI patients who presented during the same period in 2019 was also assessed (control), and the data were used for comparison. The inclusion criterion was established diagnosis of STEMI requiring PPCI. A total of 634 patients were included in the study. Results: During the COVID-19 period, the number of PPCI procedures was 25.7% lower than previous year (average 30 cases/month 30.0±4.01 compared to 40 cases/month 40.4±5.3), and the time from first medical contact to needle (FMC-to-N) was longer (125.0±53.6 min vs 52.6±22.8 min, p=0.001). Also during the COVID-19 period, the in-hospital mortality rate was higher (7.4% vs 4.6%, p=0.036), as was the incidence of re-infarction (12.2% vs. 7.7%, p=0.041) and the need for revascularization (15.9% vs 10.7%, p=0.046). The incidence of heart failure, stroke and bleeding was not different between groups, but the length of hospital stay was longer during COVID-19 (6.85±4.22 days versus 3.5±2.3 days, p=0.0025). Conclusion: At the ICC, the COVID-19 pandemic contributed significantly to the PPCI management of STEMI, with a decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.