Since the beginning of the COVID-19 pandemic there have been reports on declining numbers of admissions of patients die ST-segment myocardial infarction (STEMI), and those admitted have been observed to be in worse condition compared to before the outbreak. This included higher serum troponin T levels, higher need of catecholaminergic support, more impaired left ventricular ejection fraction, higher morbidity and in-hospital mortality. It has been suggested, that a longer time from symptom onset to first medical contact, and, consequently, prolonged total ischemic time might be responsible for this phenomenon. Amongst others, framing, misled altruistic behavior, and the fear of contagion with SARS-CoV-2 in hospital, have been discussed as potential important factors keeping STEMI patients away from seeking timely medical attention. However, reports on system delay times, patient delay times, and STEMI patients’ outcomes, and especially on mortality, are discrepant. 

Purpose:

Toperform a meta-analysis assessing the incidence of admissions of STEMI patients during the COVID-19 pandemic, and corresponding patient delay times, system delay times and mortality.  

Methods:

A comprehensive literature search was performed through PubMed, Embase, and Web of Science using the keywords “COVID” and “STEMI”. STEMI patients admitted before the COVID-19 pandemic were included in the pre-COVID-19 group, and patients admitted during the outbreak were included in the post-COVID-19 group, as defined by the respective studies. Data extraction used standardized extraction forms. This meta-analysis has been pre-registered at PROSPERO [CRD42020207153].

Results:

A total of 50.123 STEMI patients from 10 studies were enrolled in our meta-analysis, including 35.262 patients in the pre-COVID-group and 14.861 patients in the post-COVID-19 group. Assessment of baseline characteristics showed that the average age was 64.2 years with 74.3% of patients being male. There were no significant differences in baseline characteristics between both groups. Evaluation of the incidence of admissions showed that significantly fewer patients with STEMI were admitted to hospital during the COVID-19 pandemic (IRR = 0.79, 95% confidence interval (CI) = 0.73-0.85, I²=77%%). Times from symptom onset to first medical contact (FMC) did not differ significantly between the post-COVID-19 and the pre-COVID-19 group (MD=33.4 min, 95% CI = -10.2-77.1, I²=88%). Remarkably, door-to-balloon time was significantly prolonged in the post-COVID-19 group compared to the pre-COVID-19 group (MD 7.3 min, 95% CI = 3.0-11.7, I²=95%). Short-term mortality did not differ significantly between the post-COVID-19 (717 out of 14805 patients) and pre-COVID-19 group (1957 out of 35120 patients) (OR=1.2, 95% CI = 0.9-1.5, I²=57%).

Conclusions:

This is the first meta-analysis on STEMI patients admitted during the COVID-19 outbreak. Our data suggest that during the COVID-19 pandemic in-hospital mortality of STEMI patient’s has not been deteriorated, and that overall medical care could have been maintained. This might be attributable to the rapid implementation of countermeasures undertaken by the healthcare professionals. Prospective studies with a longer follow-up period are needed to further assess STEMI patient outcomes.