Impact of the COVID-19 Pandemic on the Management of Acute Myocardial Infarction

Aim: The coronavirus (COVID-19) outbreak in 2019 has negatively impacted the care of patients with other life-threatening diseases, including acute myocardial infarction (AMI). However, there is little published information concerning the depth of the impact on the clinical management and outcome following AMI. Methods: We enrolled patients with AMI who received urgent primary percutaneous coronary intervention at the Beijing Tiantan Hospital (Beijing, China) between December 1, 2019 and April 10, 2020. Patients were divided into 2 cohorts, the preCOVID-19 group (from December 1, 2019 to January 31, 2020) and during-COVID-19 group (from February 1, 2020 to April 10, 2020) for analysis. The door-to-balloon (D to B) time, total hospitalization stay (days) and coronary care unit (CCU) hospitalization days were calculated. New York Heart Association heart functional class (NYHA class), rehospitalization and death ratio in patients were assessed between the two cohorts. Results: A total of 148 AMI patients were enrolled in this study comprising 53 patients preCOVID-19 group and 95 patients during-COVID-19 group. Patients with AMI duringCOVID-19 group had longer symptom onset to hospital time (4.5 [2.0-9.3] vs 3.0 [2.0- 5.0] hours, p = 0.013) and D to B time (96 [74-119] vs 67 [52-81] minutes, p <0.001); the D to B time shortened during the study period. The two cohorts did not have significantly different number of hospitalization days, re-hospitalization rates, peak cTnI, BNP or death rates. For the one-year follow-up, the patients in the during-COVID-19 group were classified as NYHA class III-IV more frequently (9 [9.7%] vs 0 [0%], p=0.004). Conclusion: The COVID-19 pandemic significantly affected one measure of critical care of patients with AMI, NYHA classification, which may have resulted in increased medical expenses.