scholarly journals Strategies to Lower In-Hospital Mortality in STEMI Patients with Primary PCI: Analysing Two Years Data from a High-Volume Interventional Centre

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Alexandru Burlacu ◽  
Grigore Tinica ◽  
Igor Nedelciuc ◽  
Paul Simion ◽  
Bogdan Artene ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Univariate Analysis ◽  
High Volume ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Ventricular Ejection Fraction ◽  
St Elevation

Objectives. We aimed to analyse data from our high-volume interventional centre (>1000 primary percutaneous coronary interventions (PCI) per year) searching for predictors of in-hospital mortality in acute myocardial infarction (MI) patients. Moreover, we looked for realistic strategies and interventions for lowering in-hospital mortality under the “5 percent threshold.” Background. Although interventional and medical treatment options are constantly expanding, recent studies reported a residual in-hospital mortality ranging between 5 and 10 percent after primary PCI. Current data sustain that mortality after ST-elevation MI will soon reach a point when cannot be reduced any further. Methods. In this retrospective observational single-centre cohort study, we investigated two-year data from a primary PCI registry including 2035 consecutive patients. Uni- and multivariate analysis were performed to identify independent predictors for in-hospital mortality. Results. All variables correlated with mortality in univariate analysis were introduced in a stepwise multivariate linear regression model. Female gender, hypertension, depressed left ventricular ejection fraction, history of MI, multivessel disease, culprit left main stenosis, and cardiogenic shock proved to be independent predictors of in-hospital mortality. The model was validated for sensitivity and specificity using receiver operating characteristic curve. For our model, variables can predict in-hospital mortality with a specificity of 96.60% and a sensitivity of 84.68% (p<0.0001, AUC = 0.93, 95% CI 0.922–0.944). Conclusions. Our analysis identified a predictive model for in-hospital mortality. The majority of deaths were due to cardiogenic shock. We suggested that in order to lower mortality under 5 percent, focus should be on creating a cardiogenic shock system based on the US experience. A shock hub-centre, together with specific transfer algorithms, mobile interventional teams, ventricular assist devices, and surgical hybrid procedures seem to be the next step toward a better management of ST-elevation MI patients and subsequently lower death rates.

scholarly journals Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

2014 ◽  
Vol 41 (6) ◽  
pp. 660-663 ◽  
Author(s):  
Hassan Shawa ◽  
Mandeep Bajaj ◽  
Glenn R. Cunningham
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Atrioventricular Node ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction ◽  
Pacemaker Placement ◽  
Temporary Pacemaker

Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even if they have no history of hypertension. Atrioventricular node ablation and pacemaker placement should be considered for stabilizing pheochromocytoma patients with cardiogenic shock due to atrial tachyarrhythmias. A 38-year-old black woman presented with cardiogenic shock (left ventricular ejection fraction, &lt;0.15) that did not respond to the placement of an intra-aortic balloon pump. A TandemHeart® Percutaneous Ventricular Assist Device was inserted emergently. After atrioventricular node ablation and placement of a temporary pacemaker, the TandemHeart was removed. Computed tomography of the abdomen revealed a pheochromocytoma. After placement of a permanent pacemaker, the patient underwent a right adrenalectomy. This is, to our knowledge, the first reported case of pheochromocytoma-induced atrial tachyarrhythmia that led to cardiogenic shock and cardiac arrest unresolved by the placement of 2 different ventricular assist devices, but that was completely reversed by radiofrequency ablation of the atrioventricular node and the placement of a temporary pacemaker. We present the patient's clinical, laboratory, and imaging findings, and we review the relevant literature.

scholarly journals UTILITY OF SHOCK INDEX FOR PREDICTION OF CARDIOGENIC SHOCK DEVELOPED DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION

2020 ◽  
pp. 1-3
Author(s):  
Sourav Bansal ◽  
Dinesh Gautam ◽  
Shashi Mohan Sharma ◽  
Shekhar Kunal
Keyword(s):  
Heart Rate ◽  
Cardiogenic Shock ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
High Morbidity ◽  
Primary Pci ◽  
Shock Index ◽  
Ventricular Ejection Fraction ◽  
Group 2

Introduction: Cardiogenic shock (CS) is a distinct clinical entity with a high morbidity and mortality. CS after primary PCI usually portends a bad prognosis and needs prompt recognition. Shock Index (SI) serves as one of the valuable non-invasive marker for development of CS. Methods: This was a single centre prospective observational study wherein patients with ST elevated myocardial infarction (STEMI) were enrolled. In all these patients, prior to performing the coronary angiogram, shock index (SI) was calculated as heart rate (HR) divided by SBP on admission. Primary outcome was the occurrence of CS during the period of hospitalisation post primary PCI. Study population was divided into two groups: Group 1: patients with ACS without CS and Group 2: patients with ACS with CS. Results: A total of 240 patients were included in the study of whom 19 (7.9%) developed CS. Patients with CS (Group 2) had a significantly higher frequency of anterior wall MI, prior history of stroke, heart rate and a lower left ventricular ejection fraction. Multivariate logistic regression analysis revealed pre-procedure SBP, pre-procedure HR, Killip class, serum creatinine and Shock Index to be the independent predictors of developing CS post primary PCI. ROC curve showed that SI (AUC: 0.8113 ; P=0.004) had a better predictive ability as compared to pre-procedural heart rate (AUC: 0.7111; P=0.01) and pre-procedural SBP (AUC: 0.7582; P=0.001) for prediction of CS post primary PCI. Conclusion: SI is a promising tool to detect presence of shock post primary PCI in STEMI patients.

scholarly journals In-hospital results of rheolytic catheter thrombectomy in patients with STEMI

2016 ◽  
Vol 20 (3) ◽  
pp. 54
Author(s):  
M V Malkhasyan ◽  
V A Kuznetsov ◽  
I S Bessonov ◽  
P I Pavlov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Contractile Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Old Myocardial Infarction ◽  
Mean Time

<p><strong>Aim.</strong> The article focuses on the evaluation of short-term efficacy of rheolytic thrombectomy (AngioJet) in patients with STEMI. <br /><strong>Methods.</strong> 188 patients (85.6% men) with STEMI underwent primary PCI by means of rheolytic catheter thrombectomy (AngioJet). The mean age was 54.1 ± 10.7 years. 32 (17 %) of patients had old myocardial infarction. 104 (55.9 %) patients were diagnosed with ST-elevated inferior myocardial infarction. 22 (12 %) patients were operated under cardiogenic shock. Mean time from the appearance of symptoms to admission was 222.5 [70, 584] min. Anterior interventricular artery (38.3 %) and right coronary artery (43.6 %) were the main infarction-related arteries. <br /><strong>Results.</strong> Complete thrombotic occlusion of the coronary artery occurred in 144 (77.4%) patients. Mean “door-to-balloon” time amounted to 41.5 [30; 60]. Coronary thrombus was fully removed in 107 (60.8%) of patients. Stents with antiproliferative effect were implanted in 48.8 % of patients. Immediate angiographic success was achieved in 177 (94.1%) cases. Mean time of PCI was 60 [50; 80] min. PCI complications were registered in 3 (1.6%) patients. Intraoperative life-threatening arrhythmias happened in 22 (11.7 %) patients. The phenomenon of "no-reflow" occurred in 6 (3.2%) PCI cases. The rate of in-hospital mortality was 5.9%, including patients with cardiogenic shock (36.4%) and those without it (1.9 %). MACCE (main adverse cardio-cerebral events) were observed in 15 (8%) cases. According to ECG data obtained postoperatively, 26 % of patients demonstrated no regional asynergy, while a decrease in myocardial contractile function occurred in just 26 % of cases, with the average left ventricular ejection fraction running to 57.5±9 %. Mean in-hospital stay was 9.5±0.6 days.<br /><strong>Conclusion.</strong> The results of this study suggest that rheolytic catheter thrombectomy (AngioJet) is a safe and effective modality. Immediate hospital results show low rate complications and low in-hospital mortality.</p><p>Received 13 April 2016. Accepted 9 June 2016.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict interests.</p>

scholarly journals The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock

2018 ◽  
Vol 9 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Albert Ariza-Solé ◽  
José C Sánchez-Salado ◽  
Fabrizio Sbraga ◽  
Daniel Ortiz ◽  
José González-Costello ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Multiorgan Failure ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Septal Rupture ◽  
Ventricular Assist ◽  
Ventricular Ejection Fraction ◽  
And Performance ◽  
The Impact

Background: Current guidelines recommend emergency surgical correction in patients with post infarction ventricular septal rupture (PIVSR), but patients with multiorgan failure are commonly managed conservatively because of high surgical risk. We assessed characteristics and outcomes of operated PIVSR patients with or without the use of short-term ventricular assist devices (ST-VADs). We also assessed the impact of a ST-VAD on the performance of surgery Methods: We retrospectively analysed all consecutive patients with PIVSR between January 2004 and May 2017. Baseline clinical characteristics, use of ST-VAD and performance of surgery during admission were assessed. The main outcome measured was in-hospital mortality. Results: A total of 28 patients were included. Mean age was 69.2 years. Most patients (20/28, 71.4%) underwent surgical repair. ST-VADs were used in 11/28 patients (39.3%). This percentage progressively increased across the study period, from 22.2% (2/9) in 2004–2011 to 58.3% (7/12) in 2015–2017 ( p=0.091). Patients undergoing ST-VAD use had poorer INTERMACS status, higher values of creatinine, lactate and alanine aminotransferase and lower left ventricular ejection fraction as compared with operated patients without support. In-hospital mortality did not differ according to the use of ST-VADs in operated patients (27.3% without ST-VAD vs. 22.2% with ST-VAD, p=0.604). All five patients undergoing early preoperative venoarterial extracorporeal membrane oxygenator support and delayed surgery survived at hospital discharge. Conclusions: ST-VAD use increased in patients with PIVSR. Despite a higher risk profile in operated patients undergoing ST-VAD use, mortality was not significantly different in these patients. Early preoperative venoarterial extracorporeal membrane oxygenation should be considered for very high risk PIVSR patients.

Use of the Impella 5.0 Device as a Bridge to Recovery in Adult Fulminant Viral Myocarditis

2015 ◽  
Vol 10 (4) ◽  
pp. 279-281 ◽  
Author(s):  
Daniel J.P. Burns ◽  
Mackenzie A. Quantz
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Viral Myocarditis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circulatory Support ◽  
Cardiac Intensive Care Unit ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
Cardiac Intensive Care

We present a case of a 48-year-old female patient successfully bridged to recovery with the Impella 5.0 microaxial pump (Abiomed, Danvers, MA USA) after presenting with cardiogenic shock secondary to acute fulminant viral myocarditis. After 1 week of flu-like symptoms, the patient presented to her community emergency department with chest pain and hypotension. A diagnosis of inferior ST elevation myocardial infarction was made; subsequent angiography demonstrated normal coronary arteries and a left ventricular ejection fraction of 10%. A provisional diagnosis of viral myocarditis was made. As her condition deteriorated further, she underwent insertion of an Impella 5.0 after failure of supportive medical therapy. Myocardial recovery occurred, and the Impella was removed after 1 week. After a prolonged cardiac intensive care unit stay requiring temporary hemodialysis, the patient recovered sufficiently to tolerate device explant, transfer to the recovery ward, and ultimate discharge home. This case report highlights the benefit of mechanical circulatory support in a patient with cardiogenic shock from viral myocarditis as well as some of the complications that can occur in this critically ill subset of patients.

scholarly journals Cardiogenic shock due to acute coronary syndrome: characteristics and outcomes

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
JM Viegas ◽  
A Grazina ◽  
AV Goncalves ◽  
SA Rosa ◽  
L Ferreira ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Among patients admitted to a catheterization laboratory with acute coronary syndrome (ACS), a minority present with cardiogenic shock (CS). Evidence for the best way to manage these patients are needed. Aims  We aimed to assess patients’ characteristics and short and long-term outcomes of ACS presenting with CS. Methods  We analysed all ACS cases with CS admitted during a ten-year period in a tertiary care centre. We defined CS as systolic blood pressure &lt;90mmHg and signs of impaired organ perfusion with need for catecholamine therapy or presenting with cardiac arrest. At discharge, a standardized registry was performed in all cases, including clinical, electrocardiographic, echocardiographic and angiographic characteristics, and percutaneous coronary intervention (PCI) results. All patients were followed-up for two years for the occurrence of mortality (total and cardiovascular (CV)), CV hospitalizations and revascularization procedures. Results  From 3283 patients admitted with ACS, 92 (2.8%) presented with CS. Mean age was 66.0 ± 12.8 years, with 64 (69.6%) males, and 60 (65.2%) presenting with ST-segment elevation myocardial infarction. These patients presented previous ACS in 12.0%, were smokers in 28.3% and had diabetes, dyslipidemia and hypertension in 23.9%, 37.0% and 45.7%, respectively. Angiographic characteristics are described in the table. Index-PCI was successful in 83.7% cases. Multivessel coronary artery disease (CAD) was presented in 56 patients (60.9%), of which 20 (21.7%) had 3-vessel disease. Of these 56 patients, complete revascularization in the index-procedure was attempted in 11 patients (19.6%), 10 of which successfully. Mean hospitalization duration of 16.4 ± 9.5 days with in-hospital mortality of 50.0%. Unsuccessful index-PCI (p = 0.002), culprit left main coronary artery (LCMA) (p = 0.044) and reduced left ventricular ejection fraction (LVEF) (p &lt; 0,001) were significant in-hospital mortality predictors. At 12 and 24 months, survival after hospital release was 95.7% and 91.3%, respectively. At 24 months of follow-up, 40.0% had at least one CV hospitalization, 17.4% being related to a revascularization procedure (PCI 13.0%, coronary artery bypass surgery 4.4%). Conclusion  CS was uncommon among ACS patients. Unsuccessful PCI, culprit LMCA and reduced LVEF were independent predictors of in-hospital mortality. Despite a very high in-hospital mortality, long-term outcome was favourable. Abstract Figure.

Prognostic role of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock

2021 ◽  
pp. 021849232098791
Author(s):  
Yash Paul Sharma ◽  
Ganesh Kasinadhuni ◽  
Krishna Santosh ◽  
Nitin Kumar Parashar ◽  
Rakesh Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Independent Predictor ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Left Heart Failure ◽  
St Elevation

Objective Cardiogenic shock accounts for the majority of deaths amongst patients with ST-elevation myocardial infarction. Procalcitonin is elevated in acute myocardial infarction, especially when complicated by left heart failure, cardiogenic shock, resuscitated cardiac arrest, and bacterial infections. However, the prognostic utility of procalcitonin in ST-elevation myocardial infarction complicated by cardiogenic shock has not been systematically evaluated. Methods We performed a retrospective registry review of 125 patients with ST-elevation myocardial infarction and cardiogenic shock over 2 years at a tertiary referral hospital to examine the prognostic value of serum procalcitonin measurement at 24 hours after the onset of infarction for in-hospital mortality. Results The mean age of the study population was 57.75 ± 11.1 years, and the median delay from onset to hospital admission was 15 hours. The in-hospital mortality was 28.8%. Receiver operating characteristic analysis revealed a strong relationship between elevated procalcitonin and in-hospital mortality (area under the curve = 0.676; p = 0.002). Although procalcitonin was found to be higher in non-survivors in univariate analysis, it was not an independent predictor of mortality in multivariate regression analysis. Acute kidney injury, left ventricular ejection fraction, and non-revascularization were independently associated with mortality after adjusting for covariates. Conclusion Although procalcitonin was higher in non-survivors, static procalcitonin measurement at 24 hours after the onset of ST-elevation myocardial infarction complicated by cardiogenic shock was not an independent predictor of in-hospital mortality. Additional prospective studies are required to assess the role of serial procalcitonin monitoring in ST-elevation myocardial infarction complicated by cardiogenic shock.

scholarly journals Establishment and validation of a risk model for prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary PCI

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nan Gao ◽  
Xiaoyong Qi ◽  
Yi Dang ◽  
Yingxiao Li ◽  
Gang Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Model Calibration ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Ventricular Ejection Fraction ◽  
Acute Stemi ◽  
C Statistic

Abstract Background Currently, how to accurately determine the patient prognosis after a percutaneous coronary intervention (PCI) remains unclear and may vary among populations, hospitals, and datasets. The aim of this study was to establish a prediction model of in-hospital mortality risk after primary PCI in patients with acute ST-elevated myocardial infarction (STEMI). Methods This was a multicenter, observational study of patients with acute STEMI who underwent primary PCI. The outcome was in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method was used to select the features that were the most significantly associated with the outcome. A regression model was built using the selected variables to select the significant predictors of mortality. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results Totally, 1169 and 316 patients were enrolled in the training and validation sets, respectively. Fourteen predictors were identified by the LASSO analysis: sex, Killip classification, left main coronary artery disease (LMCAD), grading of thrombus, TIMI classification, slow flow, application of IABP, administration of β-blocker, ACEI/ARB, symptom-to-door time (SDT), symptom-to-balloon time (SBT), syntax score, left ventricular ejection fraction (LVEF), and CK-MB peak. The mortality risk prediction nomogram achieved good discrimination for in-hospital mortality (training set: C-statistic = 0.987; model calibration: P = 0.722; validation set: C-statistic = 0.984, model calibration: P = 0.669). Area under the curve (AUC) values for the training and validation sets are 0.987 (95% CI: 0.981–0.994, P = 0.003) and 0.990 (95% CI: 0.987–0.998, P = 0.007), respectively. DCA shows that the nomogram can achieve good net benefit. Conclusions A novel nomogram was developed and is a simple and accurate tool for predicting the risk of in-hospital mortality in patients with acute STEMI who underwent primary PCI.

scholarly journals 265 Incidence, determinants and prognostic relevance of HS-troponin and natriuretic peptides elevation at admission in hospitalized COVID-19 pneumonia patients

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N65-N79
Author(s):  
Luca Arcari ◽  
Michelangelo Luciano ◽  
Luca Cacciotti ◽  
Maria Beatrice Musumeci ◽  
Valerio Spuntarelli ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Natriuretic Peptides ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Good Ability ◽  
Myocardial Involvement ◽  
D Dimer

Abstract Aims myocardial involvement in the course of Coronavirus disease 2019 (COVID-19) pneumonia has been reported, though not fully characterized yet. Aim of the present study is to undertake a joint evaluation of hs-Troponin and natriuretic peptides (NP) in patients hospitalized for COVID-19 pneumonia. Methods and results in this multicenter observational study, we analyzed data from n = 111 COVID-19 patients admitted to dedicated “COVID-19” medical units. Hs-Troponin was assessed in n = 103 patients and NP in n = 82 patients on admission; subgroups were identified according to values beyond reference range. increased hs-Troponin and NP were found in 38% and 56% of the cases respectively. As compared to those with normal cardiac biomarkers, these patients were older, had higher prevalence of cardiovascular diseases (CVD) and more severe COVID-19 pneumonia by higher CRP and D-dimer and lower PaO2/FIO2. Two-dimensional echocardiography performed in a subset of patients (n = 24) showed significantly reduced left ventricular ejection fraction in patients with elevated NP only (p = 0.02), whereas right ventricular systolic function (tricuspid annular plane systolic excursion) was significantly reduced both in patients with high hs-Troponin and NP (p = 0.022 and p = 0.03 respectively). On multivariable analysis, independent associations were found of hs-Troponin with age, PaO2/FIO2 and D-dimer (B = 0.419, p = 0.001; B=-0.212, p = 0.013 and B = 0.179, p = 0.037 respectively), and of NP with age and previous CVD (B = 0.480, p &lt; 0.001 and B = 0.253, p = 0.001 respectively). In patients with in-hospital mortality (n = 23, 21%) hs-Troponin and NP were both higher (p = 0.001 and p = 0.002 respectively), while increasing hs-troponin and NP were associated with worse in-hospital prognosis [OR 4.88 (95% CI 1.9-12.2), p = 0.001 (adjusted OR 3.1 (95% CI 1.2-8.5), p = 0.025) and OR 4.67 (95% CI 2-10.8), p &lt; 0.001 (adjusted OR 2.89 (95% CI 1.1-7.9), p = 0.04) respectively]. Receiver operator characteristic curves showed good ability of hs-Troponin and NP in predicting in-hospital mortality (AUC = 0.869 p &lt; 0.001 and AUC = 0.810, p &lt; 0.001 respectively). Conclusion myocardial involvement at admission is common in COVID-19 pneumonia and associated to worse prognosis, suggesting a role for cardiac biomarkers assessment in COVID-19 risk stratification. Independent associations of hs-Troponin with markers of disease severity and of NP with underlying CVD might point towards existing different mechanisms leading to their elevation in this setting.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

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