Admissions for and Quality of Care of ST-Segment-Elevation Myocardial Infarction in the Post COVID-19 Era in China

OBJECTIVE: To evaluate changes in admission rates for and quality of care of ST-Segment-Elevation Myocardial Infarction (STEMI) during the period of the coronavirus disease 2019 (COVID-19) outbreak and post COVID-19 era. METHODS: We conducted a retrospective cohort study of patients with STEMI in the outbreak era (between January 23, 2020 and March 27, 2020), and the post era (between March 28, 2020, and July 31, 2020) in Suzhou Province, drawn from the China Chest Pain Center Database. RESULTS: 1965 STEMI admissions were enrolled. During the corresponding period of 2019 to the post COVID-19 era, there were a 53% and 38% fall in admissions in outbreak and the post era. There remained a gap in actual number of admissions at 306 and the predicted number that might be at 497. An estimated 26 deaths due to STEMI would have been caused by not seeking health care while no one died from COVID-19. The percentage of STEMI cases transferred by ambulance decreased from 9.3% to 4.2% (P=0.013). Door-to-balloon and the FMC-to-device median (q1, q3) time increased from 17.5 (10.0, 46.0) and 52.0 (12.0, 86.0) minutes to 34.0 (15.0, 48.0) and 63.0 (15.0, 94.0) minutes, respectively (p=0.001, p=0.005), and rate of PCI practice declined from 71.3% to 60.1% (p=0.002). CONCLUSIONS: The impact of public health restrictions in the post COVID-19 era is significant, and may lead to unexpected out-of-hospital deaths and compromised quality of STEMI care. Delay or absence in presentation in STEMI patients should be continuously considered to avoid the secondary disaster of the pandemic. System delay should be modifiable for reversing the worse clinical outcomes from the COVID-19 outbreak, by coordination measures with focus on the balance between timely PCI procedure and minimizing contamination of cardiac catheterization rooms.

[COVID-19 pandemic: global epidemiological trends and China's subsequent preparedness and responses].

The outbreak of COVID-19 has spread quickly across 114 countries/territories/areas in six continents worldwide and has been announced as a pandemic by WHO. This study analyzed global COVID-19 epidemiological trends, examined impact of the pandemic on global health security, diplomacy, and social environment in China, and provided short- and long-term strategic policy recommendations for China's subsequent preparedness and responses.