The Global Impact of the COVID-19 Pandemic on STEMI care: A Systematic Review and Meta-Analysis

Chew, Nicholas WS; Ow, Zachariah Gene Wing; Teo, Vanessa Xin Yi; Heng, Ryan Rui Yang; Ng, Cheng Han; Lee, Chi-Hang; Low, Adrian F.; Chan, Mark Yan-Yee; Yeo, Tiong-Cheng; Tan, Huay-Cheem; Loh, Poay-Huan

Background The coronavirus disease-2019 (COVID-19) pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. This review examines the global impact of COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door-to-balloon time (D2B), all-cause mortality and other secondary STEMI outcomes. Methods We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies comparing the aforementioned outcomes between STEMI patients during and before the pandemic. Results In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic respectively. Significant delay in D2B was observed during the pandemic (WMD=8.10mins; CI:3.90-12.30mins; p=0.0002, I2=90%). In-hospital mortality was higher during the pandemic (OR=1.27; CI:1.09-1.49; p=0.002, I2=36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis found that low-middle income countries observed a higher rate of mortality during the pandemic (OR=1.52; CI:1.13-2.05; p=0.006), with a similar but insignificant trend seen among the high income countries (OR=1.17; CI:0.95-1.44; p=0.13). Conclusion The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.