Association between delayed revascularization during the covid-19 pandemic and rates of post myocardial infarction heart failure hospitalizations

Abstract

Introduction: COVID-19 pandemic has changed the way patients seek medical attention and the manner medical service is provided. Purpose: To examine the changes in patient characteristics, clinical course and rates of rehospitalization due to decompensated heart failure for patients admitted with acute myocardial infarction (AMI) during the COVID-19 pandemic compared to the corresponding period in the previous year. Methods: This is a region-wide, multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI from March 11, 2020 to April 20, 2020 compared to patients admitted with the same diagnosis during the same period in the previous year. Six-month follow-up was obtained for all patients included in the study. Results: A total of 269 AMI patients were evaluated in this study. Pain-to-door times (858 [360, 2600] vs. 385.5 [200, 745] min, p < 0.0001) and troponin I levels (7.8 [2.6, 37.2] vs. 4.5 [1.1, 25.4] µg/l, p = 0.013) were significantly higher for AMI patients presenting during the pandemic. Similarly, NSTEMI patients had a significantly prolonged pain-to-door time during the pandemic than prior to it (2021 [960, 5746] vs 558 [369, 882.5] min, p < 0.0001) and there is evidence to suggest a trend toward longer door-to-wire times, as well (302.5 [179, 600] vs 200.5 [98, 434.5] min, p = 0.0948). furthermore, STEMI patients waited significantly longer before presenting to the hospital during the pandemic (582 [180, 1212] vs 262 [120, 525] min, p = 0.0003). However, door-to-wire times were similar (75 [53.5, 106.5] vs 71 [43, 119] min, p = 0.2257). Additionally, Post-revascularization ejection fraction was significantly lower for AMI patients during the pandemic (35 [30, 45] vs. 45 [40, 50] %, p < 0.0001). During follow-up we observed a significantly higher rate of re-hospitalization due to decompensated heart failure in patients admitted with NSTEMI and STEMI during the pandem[...].