BACKGROUND: There are concerns of delays in ST-segment elevation myocardial infarction (STEMI) care during the coronavirus 2019 (COVID-19) pandemic. It is unclear whether the care and outcomes of STEMI patients differ between COVID-19 waves compared to historical periods. METHODS: Consecutive patients in the Vancouver Coastal Health Authority (VCHA) STEMI database were included to compare care during 3 distinct waves of the COVID-19 pandemic (9 months; March 2020 to January 2021) with a historical non-COVID-19 cohort. We compared STEMI incidence, baseline characteristics and outcomes between groups. We also examined time from first medical contact (FMC)-to-reperfusion, symptom-to-FMC and FMC-to-STEMI diagnosis, as well as predictors of delays. RESULTS: The incidence of STEMI was similar during COVID-19 (n=305; mean 0.93/day) and pre-COVID-19 (n=949; 0.97/day p=0.80). The COVID-19 cohort showed significant delay in FMC-to-reperfusion (median:116 mins vs. 102 mins, p<0.001) and FMC-to-STEMI diagnosis (median: 17 mins vs. 11 mins, p<0.001). Delays in FMC-to-device times worsened across the first three COVID-19 waves (FMC-to-device time ≤90 minutes in wave 1: 32.9%, wave: 2: 25.6%, wave 3: 16.3%; P=0.045 (47.5% pre-COVID-19; P<0.001). There were no significant predictors of delay were unique to the COVID-19 cohort. CONCLUSIONS: This study demonstrates delays in reperfusion during the COVID-19 pandemic compared to the historical control, with delays during subsequent waves within the pandemic. It is critical to further understand these care gaps to improve STEMI care for future waves of the current and future pandemics.
Care and Outcomes of ST-Segment–Elevation Myocardial Infarction across multiple Coronavirus Disease 2019 (COVID-19) waves