Impacto de la COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia española.

Abstract

The COVID-19 outbreak has had an unclear impact on the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study was to assess changes in STEMI management during the COVID-19 outbreak. Using a multicenter, nationwide, retrospective, observational registry of consecutive patients who were managed in 75 specific STEMI care centers in Spain, we compared patient and procedural characteristics and in-hospital outcomes in 2 different cohorts with 30-day follow-up according to whether the patients had been treated before or after COVID-19. Suspected STEMI patients treated in STEMI networks decreased by 27.6% and patients with confirmed STEMI fell from 1305 to 1009 (22.7%). There were no differences in reperfusion strategy (> 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P 94% treated with primary percutaneous coronary intervention in both cohorts). Patients treated with primary percutaneous coronary intervention during the COVID-19 outbreak had a longer ischemic time (233 [150-375] vs 200 [140-332] minutes, P The number of STEMI patients treated during the current COVID-19 outbreak fell vs the previous year and there was an increase in the median time from symptom onset to reperfusion and a significant 2-fold increase in the rate of in-hospital mortality. No changes in reperfusion strategy were detected, with primary percutaneous coronary intervention performed for the vast majority of patients. The co-existence of STEMI and SARS-CoV-2 infection was relatively infrequent.

Introducción y objetivos: El impacto del brote de COVID-19 en el tratamiento del infarto agudo de miocardio con elevación del segmento ST (IAMCEST) no esta´ claro. El objetivo de este estudio es evaluar los cambios en el tratamiento del IAMCEST durante el brote de COVID-19. Métodos: Se utilizo´ un registro multice´ntrico, nacional, retrospectivo y observacional de pacientes consecutivos atendidos en 75 centros, se compararon las caracterı´sticas de los pacientes y de los procedimientos y los resultados hospitalarios en 2 cohortes segu´ n se los hubiera tratado antes o durante la COVID-19. Resultados: Los casos con sospecha de IAMCEST disminuyeron el 27,6% y los pacientes con IAMCEST confirmado se redujeron de 1.305 a 1.009 (22,7%). No hubo diferencias en la estrategia de reperfusio´n (ma´ s del 94% tratados con angioplastia primaria). El tiempo de isquemia fue ma´ s largo durante la COVID-19 (233 [150-375] frente a 200 [140-332] min; p < 0,001), sin diferencias en el tiempo primer contacto me´dico-reperfusio´n. La mortalidad hospitalaria fue mayor durante la COVID-19 (el 7,5 frente al 5,1%; OR bruta = 1,50; IC95%, 1,07-2,11; p < 0,001); esta asociacio´n se mantuvo tras ajustar por factores de confusio´n (OR ajustada = 1,88; IC95%, 1,12-3,14; p = 0,017). La incidencia de infeccio´n confirmada por SARS-CoV-2 fue del 6,3%. Conclusiones: El brote de COVID-19 ha implicado una disminucio´n en el nu´ mero de pacientes con IAMCEST, un aumento del tiempo entre el inicio de los sı´ntomas y la reperfusio´n y un aumento en la mortalidad hospitalaria. No se han detectado cambios en la estrategia de reperfusio´n. La combinacio´n de infeccio´n por SARS-CoV-2 e IAMCEST fue relativamente infrecuente.