The impact of lockdown enforcement during the SARSCoV-2 pandemic on the timing of presentation and early outcomes of patients with ST-elevation myocardial infarction

PLoS One. 2020 Oct 23;15(10):e0241149. doi: 10.1371/journal.pone.0241149. eCollection 2020.

Abstract

Introduction: Early reports described decreased admissions for acute cardiovascular events during the SarsCoV-2 pandemic. We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients.

Methods: A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020-30/4/2020). STEMI patients treated during the same period in 2019 served as controls.

Results: The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p<0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4, 3-6 Vs 5, 4-6, p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p<0.001).

Conclusions: The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Measures to improves this metric should be implemented during future lockdowns.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • COVID-19 / epidemiology
  • COVID-19 / prevention & control*
  • COVID-19 / transmission
  • COVID-19 / virology
  • Communicable Disease Control / standards*
  • Female
  • Humans
  • Israel / epidemiology
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pandemics / prevention & control
  • Patient Admission / standards
  • Patient Admission / statistics & numerical data*
  • Patient Discharge / statistics & numerical data
  • Percutaneous Coronary Intervention / statistics & numerical data
  • Prospective Studies
  • Registries / statistics & numerical data
  • SARS-CoV-2 / pathogenicity
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / surgery*
  • Time Factors
  • Time-to-Treatment / statistics & numerical data*
  • Treatment Outcome

Grants and funding

The author(s) received no specific funding for this work.