Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: a nationwide study

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dc.authorid0000-0003-3692-5227
dc.authorid0000-0002-6965-7444
dc.authorid0000-0003-1784-3584
dc.authorid0000-0002-3370-5846
dc.authorid0000-0003-3817-851X
dc.contributor.authorErol, Mustafa Kemal
dc.contributor.authorKayıkçıoğlu, Meral
dc.contributor.authorCoşgun, Mehmet
dc.contributor.authorİnanır, Mehmet
dc.contributor.authorYalçın, Osman Yasin
dc.contributor.authorGüneş, Yılmaz
dc.date.accessioned2021-06-23T18:57:17Z
dc.date.available2021-06-23T18:57:17Z
dc.date.issued2020
dc.departmentBAİBÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümüen_US
dc.description.abstractObjective: 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 recent pre-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.en_US
dc.description.sponsorshipAcknowledgments: Statistical analyses were conducted by Omega CRO, Ankara, Turkey. The same electronic case report forms and data capture program were used for both registries (OpenClinica LLC and collaborators, Waltham, MA, USA, hosted by Omega CRO, Ankara, Turkey). Both TURKMI registries are investigator-initiated trials sponsored by the Turkish Society of Cardiology, which receives major unrestricted funding from Astra-Zeneca Company for this project. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.en_US
dc.identifier.doi10.14744/AnatolJCardiol.2020.98607
dc.identifier.issn2149-2263
dc.identifier.issue5en_US
dc.identifier.pmid33122486en_US
dc.identifier.scopus2-s2.0-85094935438en_US
dc.identifier.scopusqualityQ3en_US
dc.identifier.urihttps://doi.org/10.14744/AnatolJCardiol.2020.98607
dc.identifier.urihttps://hdl.handle.net/20.500.12491/5165
dc.identifier.volume24en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakTR-Dizinen_US
dc.indekslendigikaynakPubMeden_US
dc.institutionauthorCoşgun, Mehmet
dc.institutionauthorİnanır, Mehmet
dc.institutionauthorYalçın, Osman Yasin
dc.institutionauthorGüneş, Yılmaz
dc.language.isoenen_US
dc.publisherTurkish Society of Cardiologyen_US
dc.relation.ispartofAnatolian Journal of Cardiologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectAcute myocardial infarctionen_US
dc.subjectCOVID-19en_US
dc.subjectPandemicen_US
dc.subjectTotal Ischemic Timeen_US
dc.subjectTreatment Delayen_US
dc.titleTreatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: a nationwide studyen_US
dc.typeArticleen_US

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