, Meral Kayıkçıoğlu 2
, Mustafa Kılıçkap 3
, Arda Güler 4
, Abdullah Yıldırım 5
, Fatih Kahraman 6
, Veysi Can 7
, Sinan Inci 8
, Sadettin Selçuk Baysal 9
, Okan Er 10
, Utku Zeybey 11
, Çağrı Kafkas 12
, Çağrı Yayla 13
, Can Baba Arin 14
, Ibrahim Aktaş 15
, Ahmet Arif Yalçın 4
, Ömer Genç 5
2Department of Cardiology, Faculty of Medicine, Ege University; İzmir-Turkey
3Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
4Department of Cardiology, Health Science University, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey;
5Department of Cardiology, Health Science University, Adana City Hospital; Adana-Turkey
6Department of Cardiology, Kütahya Health Science University, Evliya Çelebi Training and Research Hospital; Kütahya-Turkey
7Department of Cardiology, Health Science University, Bursa Yüksek İhtisas Training and Research Hospital; Bursa-Turkey
8Department of Cardiology, Faculty of Medicine, Aksaray University; Aksaray-Turkey
9Department of Cardiology, Health Science University, Mehmet Akif Training and Research Hospital; Urfa-Turkey
10Department of Cardiology, Denizli State Hospital; Denizli-Turkey
11Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
12Department of Cardiology, Health Science University, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital; İstanbul-Turkey
13Department of Cardiology, Health Science University, Ankara City Hospital; Ankara-Turkey;
14Department of Cardiology, Health Science University, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey
15Department of Cardiology, Health Science University, Van Training and Research Hospital; Van-Turkey
Abstract
Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1).
Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The
inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period.
Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival
increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20–3.22) for NSTEMI, p=0.007; and 2.08 (1.38–3.13) for STEMI, p<0.001].
Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI
during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the
increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare
services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42)