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Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study [Anatol J Cardiol]
Anatol J Cardiol. 2020; 24(5): 334-342 | DOI: 10.14744/AnatolJCardiol.2020.98607  

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

Mustafa Kemal Erol1, Meral Kayıkçıoğlu2, Mustafa Kılıçkap3, Arda Güler4, Abdullah Yıldırım5, Fatih Kahraman6, Veysi Can7, Sinan Inci8, Sadettin Selçuk Baysal9, Okan Er10, Utku Zeybey11, Çağrı Kafkas12, Çağrı Yayla13, Can Baba Arin14, Ibrahim Aktaş15, Ahmet Arif Yalçın4, Ömer Genç5
1Department of Cardiology, Şişli International Kolan Hospital; İstanbul-Turkey
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

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)

Keywords: Acute myocardial infarction, COVID-19, pandemic, total ischemic time, treatment delay


Mustafa Kemal Erol, Meral Kayıkçıoğlu, Mustafa Kılıçkap, Arda Güler, Abdullah Yıldırım, Fatih Kahraman, Veysi Can, Sinan Inci, Sadettin Selçuk Baysal, Okan Er, Utku Zeybey, Çağrı Kafkas, Çağrı Yayla, Can Baba Arin, Ibrahim Aktaş, Ahmet Arif Yalçın, Ömer Genç. Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study. Anatol J Cardiol. 2020; 24(5): 334-342

Corresponding Author: Meral Kayıkçıoğlu, Türkiye


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