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Treatment Delays and In-Hospital Outcomes in Acute Myocardial Infarction During the COVID-19 Pandemic: A Nationwide Study

33 Pages Posted: 2 Oct 2020

See all articles by Mustafa Kemal Erol

Mustafa Kemal Erol

Şişli International Kolan Hospital - Department of Cardiology

Meral Kayikcioglu

Ege University - Department of Cardiology

Mustafa Kilickap

Ankara University - Department of Cardiology

Arda Guler

Health Science University - Department of Cardiology

Abdullah Yildirim

Health Science University - Department of Cardiology

Fatih Kahraman

Kutahya Health Science University - Department of Cardiology

Veysi Can

Health Science University - Department of Cardiology

Sinan Inci

Aksaray University - Department of Cardiology

Sadettin Selçuk Baysal

Health Science University - Department of Cardiology

Okan Er

Denizli State Hospital - Department of Cardiology

Utku Zeybey

Trakya University - Department of Cardiology

Cagri Kafkas

Health Science University - Department of Cardiology

Cagri Yayla

Health Science University - Department of Cardiology

Can Baba Arin

Health Science University - Department of Cardiology

Ibrahim Aktas

Health Science University - Department of Cardiology

Ahmet Arif Yalcin

Health Science University - Department of Cardiology

Omer Genc

Health Science University - Department of Cardiology

TURKMI-2 Study Group

Independent

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Abstract

Background: Delay on admission of myocardial infarction (MI) is an important prognostic factor. In this nationwide registry, we compared treatment delays and outcomes of patients with acute MI in Covid-19 pandemic period with a recent pre-pandemic registry conducted at the same centres.

Methods: A recent nationwide registry (TURKMI-1) enrolled consecutive patients with acute MI in November 1-15, 2018 in Turkey, and assessed time delay at each step from symptom-onset to treatment and outcomes. Fifty centres were selected using probability sampling. In the present study (TURKMI-2), the same information was obtained from 48 of the same 50 centres during the pandemic between April 17 and May 2, 2020.

Findings: In a 2-week period, 991 patients (51·1% NSTEMI, 48·9% STEMI) were admitted to the study centres within the 48-hour of symptom-onset. Compared with the TURKMI-1, admissions decreased by 31·2% in ST-segment elevation MI (STEMI), and 56·4% in non-STEMI (NSTEMI). Median time from symptom-onset to hospital-arrival increased from 295 min to 419 min in NSTEMI, and from 150 min to 185 min in STEMI (p-values <0·001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0·448), however, total ischaemic time increased significantly (195 min vs 245 min, p=0·001) mainly due to patient-related delay. Percutaneous coronary intervention (PCI) was decreased especially in the NSTEMI group (60·3% vs 47·4% in NSTEMI, p<0·001; 94·8% vs 91·1% in STEMI, p=0·013). Major cardiac adverse events (MACE) defined as in-hospital death, heart failure, or cardiogenic shock were significantly higher in the pandemic period compared to non-pandemic (4·8% vs 8·9%; p <0·001). Age and sex adjusted risk of MACE was two times higher during pandemic (Odds ratio [95% confidence interval] was 1·96 [1·20-3·22] for NSTEMI, p=0·007; and 2·08 [1·38-3·13] for STEMI, p<0·001).

Interpretation: Besides the overall 47·1% reduction in acute MI admissions, there was a significant patient related treatment delay during the pandemic. Although PCI was performed in a timely fashion, increase in total ischaemic time and decrease in PCI might be responsible for the increased risk of MACE in acute MI.

Funding: This investigator-initiated study was funded by the Turkish Society of Cardiology, which received unrestricted grant from Astra-Zeneca Company for this project.

Declaration of Interests: Dr. Kayikcioglu reports grants from Astra Zeneca, during the conduct of the study; grants from Aegerion, other from Astra Zeneca, other from Menarini, non-financial support and other from Abbott, outside the submitted work; - Dr. Aktaş reports non-financial support from Astra Zeneca, during the conduct of the study - Dr. Kilickap reports grants from Astra_Zeneca, during the conduct of the study - Dr. Zeybey reports grants from Astra Zeneca, during the conduct of the study - Dr. Inci reports grants from Astra Zeneca , during the conduct of the study - Dr. Er reports grants from Astra Zeneca, during the conduct of the study - Dr. Kahraman reports grants from Astra Zeneca, during the conduct of the study - Dr. Yayla reports grants from Astra Zeneca, during the conduct of the study - Dr. Kafkas reports grants from Astra Zeneca, during the conduct of the study - Dr. Yildirim reports grants from Astra Zeneca, during the conduct of the study - Dr. can reports grants from ASTRA-ZENECA, during the conduct of the study - Dr Erol reports grands from Astra Zeneca, during the conduct of the study, - Dr. Yalcin reports grants from Astra Zeneca, during the conduct of the study - Dr. Guler reports grants from Astra Zeneca, during the conduct of the study - Dr. Arin reports grants from Astra-Zeneca, during the conduct of the study - Dr. Genç reports grants and non-financial support from Astra Zeneca, during the conduct of the study

Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (Ankara University Medical School; May 7, 2020; No: i4-225-20) and the Ministry of Health COVID-19 Scientific Board (May 6, 2020 No: 66175679.99.E.110223).

Keywords: Acute myocardial infarction; COVID-19; pandemic; total ischaemic time; treatment delay

Suggested Citation

Erol, Mustafa Kemal and Kayikcioglu, Meral and Kilickap, Mustafa and Guler, Arda and Yildirim, Abdullah and Kahraman, Fatih and Can, Veysi and Inci, Sinan and Baysal, Sadettin Selçuk and Er, Okan and Zeybey, Utku and Kafkas, Cagri and Yayla, Cagri and Arin, Can Baba and Aktas, Ibrahim and Yalcin, Ahmet Arif and Genc, Omer and Group, TURKMI-2 Study, Treatment Delays and In-Hospital Outcomes in Acute Myocardial Infarction During the COVID-19 Pandemic: A Nationwide Study (6/26/2020). Available at SSRN: https://ssrn.com/abstract=3638442 or http://dx.doi.org/10.2139/ssrn.3638442

Mustafa Kemal Erol

Şişli International Kolan Hospital - Department of Cardiology

Meral Kayikcioglu (Contact Author)

Ege University - Department of Cardiology ( email )

Turkey

Mustafa Kilickap

Ankara University - Department of Cardiology

TR-06590 Cebeci
Ankara
Turkey

Arda Guler

Health Science University - Department of Cardiology

Ankara
Turkey

Abdullah Yildirim

Health Science University - Department of Cardiology

Ankara
Turkey

Fatih Kahraman

Kutahya Health Science University - Department of Cardiology

Veysi Can

Health Science University - Department of Cardiology

Ankara
Turkey

Sinan Inci

Aksaray University - Department of Cardiology

Aksaray
Turkey

Sadettin Selçuk Baysal

Health Science University - Department of Cardiology

Ankara
Turkey

Okan Er

Denizli State Hospital - Department of Cardiology

Utku Zeybey

Trakya University - Department of Cardiology

Edirne
Turkey

Cagri Kafkas

Health Science University - Department of Cardiology

Ankara
Turkey

Cagri Yayla

Health Science University - Department of Cardiology

Ankara
Turkey

Can Baba Arin

Health Science University - Department of Cardiology

Ankara
Turkey

Ibrahim Aktas

Health Science University - Department of Cardiology

Ankara
Turkey

Ahmet Arif Yalcin

Health Science University - Department of Cardiology

Ankara
Turkey

Omer Genc

Health Science University - Department of Cardiology

Ankara
Turkey

TURKMI-2 Study Group

Independent

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