ST-Segment Elevation Myocardial Infarction Metrics Before and During the COVID-19 Pandemic: Experience from a Brazilian Center

Abstract

Background:

The impact of the COVID-19 pandemic on the healthcare of patients with ST-segment elevation acute myocardial infarction (STEMI) in Brazil remains unclear.

Objective:

Provide a descriptive analysis of clinical profiles, time intervals, performance metrics, and outcomes in patients with STEMI before and during the COVID-19 pandemic.

Methods:

Among a cohort of 193 patients with STEMI diagnosed in five emergency departments within a single Brazilian healthcare network, 187 patients were included between January 2017 and April 2021 and stratified into two cohorts: Cohort I (pre-pandemic, 146 patients) and Cohort II (pandemic, 41 patients). Statistical significance was defined as a two-sided p value < 0.05.

Results:

The mean age of the participants was 62.7 years (standard deviation: 13.2); 83.4% were male, and 86.1% underwent primary percutaneous coronary intervention (PCI). Duration from symptom onset to emergency department presentation was 60 minutes in both cohorts (interquartile range, IQR: 30 to 150 in Cohort I versus 30 to 152 in Cohort II, p = 0.273). Total ischemic time was 132 minutes in Cohort I (IQR: 94 to 222), and 117 minutes in Cohort II (IQR: 76.3 to 185.6) (p = 0.159). The observed STEMI time delays and performance metrics were comparable between groups, with reperfusion rates within the recommended time frame above 90% in both cohorts. Hospital mortality was 3.4% in Cohort I and 7.3% in Cohort II (p = 0.376).

Conclusion:

In the context of the COVID-19 pandemic, within a private healthcare network system in Brazil, this study did not uncover statistically significant disparities in clinical profiles, time intervals, performance metrics, or in-hospital mortality when compared to the pre-pandemic period.