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April 14, 2020
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Cath lab activations for STEMI down 38% during COVID-19 pandemic

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Santiago Garcia

The number of STEMI activations in U.S. cardiac catheterization laboratories has decreased during the COVID-19 pandemic, according to research published in the Journal of the American College of Cardiology.

Data such as these have prompted cardiology societies to issue statements urging patients with MI or stroke to seek medical treatment immediately.

“The COVID-19 pandemic has significantly impacted the U.S. health care system,” Santiago Garcia, MD, director of the adult congenital structural heart disease program at the Valve Science Center at the Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, told Healio. “Anecdotal reports suggested a decline in primary percutaneous coronary intervention volumes in the U.S. and around the world during the early phase of the pandemic. Current guidelines recommend primary percutaneous coronary interventions for patients presenting with ST-elevation myocardial infarction even during the pandemic.”

STEMI activations

Researchers analyzed STEMI activations from nine high-volume cardiac catheterization laboratories in the U.S. from January 2019 to March 2020. March 1, 2020, was determined to be the start of the “after COVID-19” period when medical operations and social life in the U.S. were significantly affected by the pandemic. The “before COVID-19” period was defined as the 14 months before the pandemic, or from January 2019 to February 2020.

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STEMI activation at nine high-volume U.S. cath labs before and during the COVID-19 pandemic.

Researchers observed a 38% decrease in STEMI activations from before the pandemic to after it started to affect life in the U.S. (95% CI, 26-49). Before the pandemic, the sites from the study reported more than 180 STEMI activations per month, with a mean of 23.6 activations per month per center. This decreased to 138 activations per month, with a mean of 15.3 activations per month per center, for the period beginning March 1, 2020.

“It is important to understand if patient-based anxiety is decreasing presentation of STEMI patients to the U.S. hospital system,” Garcia said in an interview. “Potential etiologies for the decrease in STEMI primary percutaneous coronary intervention activations include avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital, STEMI misdiagnosis and increased use of pharmacological reperfusion due to COVID-19.”

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Professional society statements

In response to reports that patients with urgent medical needs may be avoiding hospitals during the pandemic, several professional societies released statements on the importance of seeking medical help when experiencing MI and stroke.

Martha Gulati

“Due to fears of contracting COVID-19 or taking up space in hospitals, patients experiencing a heart attack or stroke are delaying their essential care, causing a new public health crisis,” Martha Gulati, MD, FACC, division chief of cardiology at University of Arizona College of Medicine – Phoenix, physician executive director at Banner – University Medicine Heart Institute in Phoenix and editor-in-chief of American College of Cardiology’s CardioSmart, said in a press release from the ACC. “Hospitals and catheterization labs are still treating heart attack and stroke, not just COVID-19, and are taking the utmost precautions to ensure that the novel coronavirus not be spread. The faster a patient is treated, the higher the outcome of survival and lower the risk for complications. No patient should delay their care.”

The European Society of Cardiology also released a statement emphasizing the importance of timely care, especially in patients with MI.

“Instructions to ‘stay at home’ and ‘don’t come to the hospital’ do not apply to patients with heart attack symptoms,” Barbara Casadei, MD, associate professor of cardiovascular medicine for the British Heart Foundation and president of the ESC, said in a press release from the organization. “There are specific lifesaving and evidence-based treatments for heart attacks, but they need to be administered quickly to be most effective. Delaying puts your life at risk, increases the damage to your heart and the risk of developing heart failure.” – by Darlene Dobkowski

For more information:

Santiago Garcia, MD, can be reached at santiagogarcia@me.com.

Disclosures: The authors and Gulati report no relevant financial disclosures. Casadei is president of the ESC.