Analysis of the Prognosis Outcomes and Treatment Delay Among ST-Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-۱۹

Background During COVID-۱۹ pandemic, the emergency department (ED) was challenged to treat patients with COVID-۱۹-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-۱۹ pandemic due to isolation or precaution and compare it with pre-COVID-۱۹ period.Methods This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center’s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within ۲۸ days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on ۲۸-day in-hospital mortality.Results Door-to-balloon time was longer in STEMI patients with COVID-۱۹-related symptom(s) than those without symptom during the COVID-۱۹ period (۹۷.۰ [۷۴.۸, ۱۳۹.۸] vs. ۶۹.۰ [۵۵.۰, ۱۰۲.۰] minutes, P<.۰۰۱). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-۱۹-related symptom(s) during the pre-COVID-۱۹ period (۷۳.۰ [۶۱.۰, ۹۲.۰] vs. ۶۷.۰ [۵۴.۵, ۸۰.۰] minutes, P=.۲۸۶۹). The ۲۸-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-۱۹ during the pre-COVID-۱۹ period (۱۵.۴% vs. ۶.۸%, P=.۱۲۵۷). However, it was significantly higher during the COVID-۱۹ period (۲۱.۱% vs. ۶.۷%, P=.۰۱۰۲) in patients with COVID-۱۹ suggestive symptoms than in patients without the symptoms.Conclusion In Korea, symptoms suggestive of COVID-۱۹ during the pandemic had a significant effect on the increase of door-to-balloon time and ۲۸-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.

Keywords:

Emergency Service , COVID-۱۹ , Patient Safety , Myocardial Infarction , Isolation , Korea