COMPARISON OF HOSPITALIZATION RATES AND CLINICAL OUTCOMES FOR ST ELEVATION MYOCARDIAL INFARCTIONS BEFORE AND AFTER COVID-19 PANDEMIC

Abstract

Objective: To evaluate and compare the impact of COVID-19 pandemic on admission rates and mortality in patientsm presenting with ST elevation myocardial infarction (STEMI) to a tertiary care cardiac setup in Pakistan.

Study Design: Comparative cross-sectional study

Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD) Rawalpindi, from Apr to May 2020.

Methodology: All ST elevation myocardial infarction patients presenting to our hospital for two months (April, May) during COVID-19 pandemic were studied. Similar patients were also analyzed from pre-COVID era for an equivalent period. Parameters compared include total number of ST elevation myocardial infarction patients, age, gender, door to balloon (DTB) time, MI type (anterior versus non-anterior) and prognosis in terms of mortality. Categorical variables are presented as absolute numbers and percentages and compared by chi-square test. Odds ratio was determined to study the impact of COVID-19
pandemic on ST elevation myocardial infarction mortality. SPSS-23 was used for all the analysis.

Results: We observed a significant 43% reduction in the total numbers of ST elevation myocardial infarction admissions compared to equivalent time before pandemic. There was a decrease in patients >75 years of age (4.1%, p-value 0.007), decrease in female patients (21.7%, p-value 0.001), mild improvement in door to balloon (1.3%, p-value 0.4), increase in anterior MI (1.2%, p-value 0.7). The ST elevation myocardial infarction case fatality rate during the pandemic increased from 4-7.1% (Odds ratio 1.81, confidence interval 1.01 to 3.24, p-value 0.04).

Conclusion: Although ST elevation myocardial infarction admissions decreased after COVID-19 but there was a paradoxical increase in mortality. Late presentation to hospital due to contagion fear, various lockdown measures, unavailability of public transport, economic instability may be some of the contributing factors, in addition to the COVID-19 infection itself, that need to be studied further.