Aims:

Since the outbreak of the COVID-19 pandemic, hospitals worldwide reported declining numbers of patients admitted with acute coronary syndrome. One suspected reason for this is the patients‘ fear of infection with the SARS-CoV-2 virus. In the trade press, this phenomenon is already referred to as "collateral damage" of the pandemic, as an extended time of total ischemia, caused by a delayed presentation of the patients, can have a negative effect on the clinical prognosis. However, at this stage, prospective data on patients with acute myocardial infarction during the COVID-19 pandemic are sparse in relation to their clinical condition at presentation and outcome.

Methods and Results:

In our prospective observational cohort study, we included STEMI patients admitted during the COVID-19 pandemic between March 21, 2020 and July 31, 2020 (COVID-19 group). Patients admitted between November 1, 2019 and March 20, 2020 served as the control group (pre-COVID-19 group).

The primary outcome was survival. Secondary outcomes were clinical symptoms, as measured by NYHA- and CCS-class, serum cardiac Troponin levels T, serum NT-pro BNP levels, and left ventricular systolic function (LVEF). Additionally, we assessed factors suspected to be related to a delayed admission of patients. 

Out of the 124 included patients, the outcomes of 57 patients in the pre-COVID-19 group and 67 patients in the COVID-19 group were assessed. At the time of admission, LVEF was significantly lower in the COVID-19 group (45% vs. 53%; p=0.012). Moreover, patients in the COVID-19 group received circulatory support significantly more often (31% vs. 13%; 19 vs. 7 patients; p=0.020), and were more likely to be transferred to the ICU (94% vs. 70%; 63 vs. 40 patients; p=0.001). However, there were no significant differences for survival (HR:1.96;95%CI:0.84–4.55;p=0.106), and for secondary outcomes between both groups. For the evaluated reasons for delayed admission, we found that in the COVID-19 group significantly more patients stated that “information by the media” made them hesitate to contact emergency medical services (11% vs. 0%; 5 of 46 vs. 0 of 47 patients; p=0.026).

Conclusion:

To our knowledge, this is the first study prospectively evaluating STEMI patients’ outcomes admitted during the COVID-19 pandemic. Patients of the COVID-19 group were in worse clinical condition at the time of admission. We did not detect significant differences in the patients’ survival and other clinical outcomes between the pre-COVID19 group and COVID-19 group. Our results suggest that overall adequate medical care for STEMI patients has been maintained during the pandemic. Additionally, information by the media appears to be able to negatively affect the health behavior of STEMI patients. Consequently, it is of the essence to increase the awareness heart attack signs in the general population to avoid potential negative outcomes.