TY  - JOUR
TI  - Treatment delays and in-hospital outcomes in acute myocardialinfarction during the COVID-19 pandemic: A nationwide study
AB  - 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 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. (Anatol J Cardiol 2020; 24: 334-42)
AU  - KILICKAP, MUSTAFA
AU  - Er, Okan
AU  - Kayikcioglu, Meral
AU  - Kahraman, Fatih
AU  - YAYLA, ÇAĞRI
AU  - Can, Veysi
AU  - Kafkas, Cagrı
AU  - aktaş, ibrahim
AU  - Güler, Arda
AU  - ZEYBEY, UTKU
AU  - Erol, Mustafa Kemal
AU  - baysal, sadettin selçuk
AU  - inci, sinan
AU  - genç, ömer
AU  - YALCIN, AHMET ARIF
AU  - ARIN, Can Baba
AU  - yıldırım, abdullah
DO  - 10.14744/AnatolJCardiol.2020.98607
PY  - 2020
JO  - The Anatolian Journal of Cardiology
VL  - 24
IS  - 5
SN  - 2149-2263
SP  - 334
EP  - 342
DB  - TRDizin
UR  - http://search/yayin/detay/425338
ER  -