International Journal of Cardiovascular Sciences. 25/fev/2025;38:e20240022.

Delay Times in Acute Myocardial Infarction Care: Comparison Between Periods Before and During the COVID-19 Pandemic

Layla Pasolini Lott , Roberto Ramos Barbosa , Rhaaby Rodrigues Muzi , Camila Marianelli , Isadora Cardozo Bragatto , Valentin Trevizani Neto , Glícia Chierici Baptista , Eduardo Gomes Vieira, Rodolfo Costa Sylvestre , Osmar Araújo Calil , Renato Giestas Serpa , Lucas Crespo de Barros , Larissa Novaes Paganini, Lucas Martins Frizzera Borges, Luiz Fernando Machado Barbosa

DOI: 10.36660/ijcs.20240022

Abstract

Background

The success of acute myocardial infarction with ST-segment elevation (STEMI) treatment is time-dependent, requiring prompt access, diagnosis, and immediate medical intervention. The COVID-19 pandemic has significantly impacted the care of patients with STEMI.

Objective

To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) before and during the COVID-19 pandemic.

Methods

This retrospective observational study included patients with STEMI undergoing PPCI from June 2019 to July 2022. The COVID-19 pandemic period was divided into 3 time groups. Pandemic I referred to the interval from March to August 2020, pandemic II from September 2020 to July 2021, and pandemic III from August 2021 to July 2022. Delay times, clinical characteristics, and in-hospital mortality were analyzed. The chi-square, Fisher’s exact, Student’s t and one-way ANOVA tests were applied, with p values less than 0.05 being considered statistically significant.

Results

Comparing the periods, the total ischemic time to PPCI was 346.3 versus 448.4 versus 398.4 versus 348.4 minutes (p = 0.47); onset-to-door time 253.1 versus 421.1 versus 377.4 versus 370.6 minutes (p = 0.42); first medical contact (FMC)-to-balloon time 243.9 versus 313.0 versus 239.5 versus 279.4 minutes (p = 0.38); and door-to-balloon time 71.8 versus 76.8 versus 58.03 versus 88 minutes (p = 0.9). Mortality significantly increased in pandemic I compared to pre-pandemic (29.4% versus 5.0%, p = 0.01), with a marginal difference compared to pandemic II and III combined (12.2%, p = 0.05).

Conclusion

There was a trend toward increased onset-to-door time and FMC-to-balloon time in STEMI care during the pandemic compared to the pre-pandemic period, although not statistically significant. Higher mortality in STEMI was observed in the first months of the COVID-19 pandemic.