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Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic

Wu, J; Mamas, M; Rashid, M; Weston, C; Hains, J; Luescher, T; De Belder, MA; ... Gale, CP; + view all (2020) Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic. European Heart Journal - Quality of Care and Clinical Outcomes 10.1093/ehjqcco/qcaa062. (In press).

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Abstract

AIM: COVID-19 might have affected the care and outcomes of hospitalised acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment and mortality from AMI. METHODS AND RESULTS: Admission were classified as non ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1st January, 2019 and 22nd May, 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23rd March, 2020 (UK lockdown) median daily hospitalisations decreased more for NSTEMI (69 to 35; IRR 0.51, 95% CI 0.47-0.54) than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19th April, 2020. During lockdown, patients were younger (mean age 68.7 years vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%) or had cerebrovascular disease (7.0% vs. 8.6%). STEMI more frequently received primary PCI (81.8% vs 78.8%%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 hours), median duration of hospitalisation decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each >94.7%). Mortality at 30 days increased for NSTEMI (from 5.4% to 7.5%; OR 1.41, 95% CI 1.08-1.80), but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSIONS: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less co-morbid and, for NSTEMI, had higher 30-day mortality.

Type: Article
Title: Patient response, treatments and mortality for acute myocardial infarction during the COVID-19 pandemic
Location: England
DOI: 10.1093/ehjqcco/qcaa062
Publisher version: https://doi.org/10.1093/ehjqcco/qcaa062
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: myocardial infarction, acute; angiogram; non-st elevated myocardial infarction; st segment elevation myocardial infarction; myocardial ischemia; cerebrovascular disorders; pharmacotherapy; diabetes mellitus; thrombolytic therapy; hospitalization; length of stay; mortality; secondary prevention; seasonal variation; covid-19; coronavirus pandemic
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10109004
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