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Association of the COVID-19 Pandemic on Treatment Times for ST-Elevation Myocardial Infarction: Observations from the Los Angeles County Regional System.
Shavelle, David M; Bosson, Nichole; French, William J; Thomas, Joseph L; Niemann, James T; Gausche-Hill, Marianne; Rollman, Jeffrey Eric; Rafique, Asim M; Klomhaus, Alexandra M; Kloner, Robert A.
Affiliation
  • Shavelle DM; Memorial Care Heart and Vascular Institute, Long Beach Medical Center, Long Beach, California. Electronic address: dshavelle@memorialcare.org.
  • Bosson N; Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California.
  • French WJ; David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA.
  • Thomas JL; David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA.
  • Niemann JT; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California.
  • Gausche-Hill M; Los Angeles County EMS Agency, Sante Fe Springs, California; David Geffen School of Medicine, University of California, Los Angeles, California; Department of Emergency Medicine, Harbor UCLA Medical Center, Torrance, California.
  • Rollman JE; Department of Health Policy and Management, UCLA Fielding School of Public Health.
  • Rafique AM; David Geffen School of Medicine, University of California, Los Angeles, California; Division of Cardiology, Department of Medicine, and.
  • Klomhaus AM; Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
  • Kloner RA; Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institutes, Pasadena, California.
Am J Cardiol ; 213: 93-98, 2024 Feb 15.
Article in En | MEDLINE | ID: mdl-38016494
ABSTRACT
Previous studies have documented longer treatment times and worse outcomes for patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) during the COVID-19 pandemic. The objective of the present study was to evaluate the impact of the COVID-19 pandemic on treatment times and outcomes for patients with STEMI who underwent primary PCI within a regional system of care. This was a retrospective study using data from the Los Angeles County Emergency Medical Services Agency. Data on the emergency medical service activations were abstracted for patients with STEMI from March 19, 2020 to January 31, 2021, during the COVID-19 pandemic and for the same interval the previous year. All adult patients (≥18 years) with STEMI who underwent emergent coronary angiography were included. The primary end point was the first medical contact (FMC) to device time. The secondary end points included treatment time intervals, vascular complications, need for emergent coronary artery bypass surgery, length of hospital stay, and in-hospital mortality. During the study period, 3,017 patients underwent coronary angiography for STEMI, 1,893 patients pre-COVID-19 and 1,124 patients during COVID-19 (40% lower). A total of 2,334 patients (77%) underwent PCI. During the COVID-19 period, rates of PCI were significantly lower compared with the control period (75.1% vs 78.7%, p = 0.02). FMC to device time was shorter during the COVID-19 period compared with the control period (median 77.0 vs 81.0 minutes, p = 0.004). For patients with STEMI complicated by out-of-hospital cardiac arrest, FMC to device time was similar during the COVID-19 period compared with the control period (median 95.0 [33.0] vs 100.0 [40.0] minutes, p = 0.34). Vascular complications, the need for emergent bypass surgery, length of hospital stay, and in-hospital mortality were similar between the periods. In conclusion, in this large regional system of care, we found a relatively small but significant decrease in treatment times, yet overall, similar clinical outcomes for patients with STEMI who underwent primary PCI and were treated during the COVID-19 period compared with a control period. These findings suggest that mature cardiac systems of care were able to maintain efficient care despite the challenges of the COVID-19 pandemic.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 Limits: Adult / Humans Country/Region as subject: America do norte Language: En Journal: Am J Cardiol Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 Limits: Adult / Humans Country/Region as subject: America do norte Language: En Journal: Am J Cardiol Year: 2024 Document type: Article
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