With the declaration of COVID-19 as a global
pandemic, states initially opted to cancel all elective
procedures and place emphasis on the importance
of staying at home for patients and their families.
These measures resulted in a notable reduction in
the number of non-COVID-19-related complaints
presented to the emergency department. European
countries have observed a significant decrease in
the incidence of STEMI cases since the onset of the pandemic, prompting inquiry into the potential
factors contributing to this change. A study
conducted by the Spanish Society of Cardiology,
along with similar findings in Hong Kong, reported
a decline of up to 40% in PCI procedures for
STEMI.[
11]
Our study aimed to examine whether there
were any disparities in the emergency management
of STEMI patients between the pre-COVID-19
and COVID-19 periods. In our investigation, we
found no statistically significant differences in the
age and sex distributions of patients who sought
care at the emergency department during both the
pre-COVID-19 and COVID-19 periods. Similarly,
Ayad et al.[12] conducted a study that revealed no
significant distinctions in the age and sex of patients
between the two periods.
When comparing the timing of STEMI patients'
presentations at the emergency department in the
pre-COVID-19 and COVID-19 periods, it was
observed that during the pre-COVID-19 period,
139 patients arrived within a time frame of less
than 2 h, whereas in the COVID-19 period, only
68 patients arrived within the same time frame.
Notably, STEMI patients exhibited a significant
delay in seeking care at the emergency department
during the COVID-19 period. Hammad et al.'s[13]
study reported that during the COVID-19 period,
35 patients with STEMI presented themselves 12 h
after experiencing symptoms. Furthermore, 27% of
these patients refrained from seeking care due to fear
of COVID-19, 18% attributed their symptoms to
COVID-19, and 9% wished to avoid burdening the
emergency department amidst the pandemic. Given
the retrospective nature of our study, we were unable
to explore the specific reasons for these delays in
presentation. However, it is plausible that concerns
surrounding infection, movement restrictions, and
the desire to minimize the strain on hospitals may
have contributed to this situation.[14]
In our investigation, the mean duration from
the moment the patient manifested symptoms of
STEMI to the time of admission for CAG was found
to be 51.61±35.32 min during the pre-COVID-19
era. However, in the COVID-19 era, this time frame
was reduced to 49.09±46.59 min. Existing literature
has shown that the period for patient admission
for CAG has increased during the COVID-19 era
compared to the pre-COVID-19 era, as stated in numerous studies.[12,13,15,16] In our research, although
no statistically significant outcome was obtained,
it was observed that CAG procedures were carried
out more expeditiously within our hospital during
the COVID-19 era. During this time, patients
presenting with STEMI symptoms were admitted
for CAG without waiting for polymerase chain
reaction (PCR) test results, assuming that each
patient had COVID-19. They were then examined
and treated according to the latest guidelines. All
healthcare professionals in our hospital quickly
evaluated the patients while ensuring their own
personal safety measures. In our hospital, patients
with STEMI who required emergency CAG were
taken to the angiography room without waiting for
PCR results. In addition, as in the whole world, the
number of patients presenting to our hospital during
the COVID-19 period decreased compared to the
pre-COVID-19 period.[15,16] It was thought that the
decrease in the number of presenting patients and
the resulting decrease in the workload on healthcare
professionals contributed to the shortening of the
admission time for CAG during the COVID-19
period.
In our study, the mean time for STEMI patients
to be consulted with cardiology after receiving
a diagnosis was 15.90±21.97 min. In the study
conducted by Duygu[17] in our hospital in 2012, this
duration was reported to be an median of 17 min.
The relatively shorter consultation times for patients
diagnosed with STEMI in our hospital indicate
an improvement in the diagnosis process. In our
hospital, using current guidelines for the diagnosis
and treatment of patients presenting with chest
pain and the healthcare personnel's dedication to
ensuring personal safety throughout the diagnosis
and treatment process were considered significant
factors in shortening the diagnosis process. In our
study, when treatment decisions were evaluated,
statistically significant differences were found in
the pre-COVID-19 and COVID-19 periods. In the
COVID-19 period, it was thought that not waiting
for PCR results by assuming that patients were
infected with COVID-19 and taking personal safety
measures increased the rate of emergency PCI due to
the decrease in the number of patients presenting to
the emergency department. Studies recommending
delaying CAG or using thrombolytic therapy until
the infection status with COVID-19 becomes clear
exist in the literature.[18,19] However, in our hospital, the gold standard treatment for STEMI, which is
CAG, was continued to be applied without delay.
In the study conducted by Xiang et al.[14] an
increase in mortality was observed during the
pandemic period. However, in our study, it was
observed that the mortality rates did not change in
the pre-COVID-19 and COVID-19 periods. It was
thought that the implementation of a standardized
diagnosis and treatment process in line with current
guidelines and not delaying the CAG procedure were
the main reasons for the nonincrease in mortality in
our hospital.
The relatively low number of patients in our
study, insufficient patient admissions during the
COVID-19 pandemic, inability to reach a sufficient
number of COVID-19-positive STEMI patients,
short-term follow-up of patients, and obtaining
patient information from records are important
limitations to this study.
In conclusion, a decrease was observed in the
number of patients diagnosed with STEMI and
the number of admissions within the critical first
2 h after symptom onset due to concerns related
to the COVID-19 pandemic. The time taken for
patients to be referred to cardiology after being
diagnosed with STEMI at our center was not
affected by seasonal changes. The door-to-needle
time was accomplished in a shorter period during the
COVID-19 pandemic. Patients at our center were
admitted to the catheterization laboratory at the same
speed, regardless of whether it was before or during
the pandemic. As a result, this study did not observe
any adverse effects of the pandemic period on the
emergency management of patients diagnosed with
STEMI.
Ethics Committee Approval: The study protocol was
approved by the Dokuz Eylül University Faculty of Medicine
Ethics Committee (date: 22.02.2021, no: 2021/06-03). The
study was conducted in accordance with the principles of the
Declaration of Helsinki.
Patient Consent for Publication: A written informed
consent was obtained from each patient.
Data Sharing Statement: The data that support the
findings of this study are available from the corresponding
author upon reasonable request.
Author Contributions: Design, data collection, analysis
and writing were made: S.K.; Supervision and critical review
were made: F.C.; Materials were made: B.Ş.; Literature review
and references were made: A.A.B.
Conflict of Interest: The authors declared no conflicts
of interest with respect to the authorship and/or publication
of this article.
Funding: The authors received no financial support for
the research and/or authorship of this article.
){kind=link}
){kind=link}
){kind=link}