Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 11, Number 6, December 2020, pages 386-391

Delays in Presentation in Patients With Acute Myocardial Infarction During the COVID-19 Pandemic

Figure 1. Time delays in patients presenting with NSTEMI. NSTEMI: non-ST-segment elevation myocardial infarction.

Figure 2. Time delays in patients presenting with STEMI. STEMI: ST-segment elevation myocardial infarction.

**Table 1.** Characteristics and Clinical Course of Patients Presenting With Acute Myocardial Infarction During (March 2020) and Before (March 2019) the COVID-19 Pandemic
Variable	NSTEMI	STEMI
Superscripts indicate missing data in each of the four groups. Hypertension: patients receiving antihypertensive therapy prior to admission or had to be initiated on antihypertensive therapy during hospitalization due to consistently elevated blood pressure of ≥ 140/90 mm Hg. Obesity: body mass index ≥ 30 kg/m². NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention.
Male	22 (73%)	37 (60%)	0.2005	34 (72%)	39 (65%)	0.4183
Age (years)	70 (64, 80)	69.5 (60, 79)	0.5401	67 (59, 76)	68.5 (59, 83)	0.3179
Obesity	16 (53%)	25 (40%)	0.2392	19 (40%)	20 (33%)	0.4493
Hypertension ^{(0, 1, 1, 0)}	29 (97%)	56 (92%)	0.6594	40 (87%)	54 (90%)	0.6240
Smoking ^{(1, 1, 1, 0)}	5 (17%)	11 (18%)	0.9269	10 (22%)	15 (25%)	0.6951
Diabetes mellitus ^{(0, 1, 1, 0)}	10 (33%)	16 (26%)	0.4807	11 (24%)	11 (18%)	0.4826
Coronary artery disease	15 (50%)	25 (40%)	0.3801	18 (38%)	17 (28%)	0.2756
Prior coronary artery bypass grafting ^{(1, 1, 1, 0)}	7 (24%)	2 (3.3%)	0.0044	3 (6.5%)	1 (1.7%)	0.3144
Chronic obstructive pulmonary disease ^{(0, 1, 1, 0)}	0 (0%)	1 (1.6%)	1.0000	1 (2.2%)	2 (3.3%)	1.0000
Peripheral arterial disease ^{(1, 1, 1, 0)}	3 (10%)	1 (1.6%)	0.0965	0 (0%)	2 (3.3%)	0.5040
Cerebrovascular disease ^{(1, 1, 1, 0)}	3 (10%)	5 (8.2%)	0.7092	4 (8.7%)	5 (8.3%)	1.0000
Pain-to-door time (min) ^{(0, 2, 0, 1)}	1,855 (880, 5,732)	606 (388, 944)	< 0.0001	620 (255, 1,500)	349 (146, 659)	0.0141
Door-to-reperfusion time (min) ^{(5, 23, 4, 3)}	332 (182, 581)	194 (92, 329)	0.0371	76 (64, 113)	86 (56, 126)	0.9833
Number of diseased vessels ^{(0, 1, 0, 0)}	2 (2, 3)	2 (1, 3)	0.1857	2 (1, 3)	2 (1, 3)	0.6462
Ejection fraction after PCI ^{(2, 3, 2, 2)}	42.5 (38, 49)	48 (40, 50)	0.1235	43 (35, 50)	40 (35, 45)	0.4401
Reperfusion strategy			0.1073			1.0000
Coronary artery bypass grafting surgery	2 (7%)	13 (21%)		2 (4%)	2 (3%)
PCI	25 (83%)	38 (61%)		44 (94%)	57 (95%)
Non-obstructive CAD	3 (10%)	11 (18%)		1 (2%)	1 (2%)
Angiography access			0.0001			0.8034
Femoral	10 (33%)	7 (11%)		7 (15%)	10 (17%)
Right radial	16 (53%)	55 (89%)		40 (85%)	50 (83%)
Left proximal radial	4 (13%)	0 (0%)		0 (0%)	0 (0%)
Culprit vessel ^{(5, 23, 3, 3)}			0.3404			0.0319
Right coronary artery	4 (16%)	4 (10%)		12 (27%)	14 (25%)
Left main	2 (8%)	10 (26%)		1 (2.3%)	12 (21%)
Left anterior descending	10 (40%)	13 (33%)		26 (59%)	23 (40%)
Left circumflex	9 (36%)	12 (31%)		5 (11%)	8 (14%)
Right coronary dominance	26 (87%)	56 (90%)	0.7231	37 (79%)	56 (93%)	0.0261

Table 1. Characteristics and Clinical Course of Patients Presenting With Acute Myocardial Infarction During (March 2020) and Before (March 2019) the COVID-19 Pandemic

Variable

NSTEMI

STEMI

2020 (n = 30)

2019 (n = 62)

P value

2020 (n = 47)

2019 (n = 60)

P value

Superscripts indicate missing data in each of the four groups. Hypertension: patients receiving antihypertensive therapy prior to admission or had to be initiated on antihypertensive therapy during hospitalization due to consistently elevated blood pressure of ≥ 140/90 mm Hg. Obesity: body mass index ≥ 30 kg/m². NSTEMI: non-ST-segment elevation myocardial infarction; STEMI: ST-segment elevation myocardial infarction; PCI: percutaneous coronary intervention.

Male

22 (73%)

37 (60%)

0.2005

34 (72%)

39 (65%)

0.4183

Age (years)

70 (64, 80)

69.5 (60, 79)

0.5401

67 (59, 76)

68.5 (59, 83)

0.3179

Obesity

16 (53%)

25 (40%)

0.2392

19 (40%)

20 (33%)

0.4493

Hypertension ^{(0, 1, 1, 0)}

29 (97%)

56 (92%)

0.6594

40 (87%)

54 (90%)

0.6240

Smoking ^{(1, 1, 1, 0)}

5 (17%)

11 (18%)

0.9269

10 (22%)

15 (25%)

0.6951

Diabetes mellitus ^{(0, 1, 1, 0)}

10 (33%)

16 (26%)

0.4807

11 (24%)

11 (18%)

0.4826

Coronary artery disease

15 (50%)

25 (40%)

0.3801

18 (38%)

17 (28%)

0.2756

Prior coronary artery bypass grafting ^{(1, 1, 1, 0)}

7 (24%)

2 (3.3%)

0.0044

3 (6.5%)

1 (1.7%)

0.3144

Chronic obstructive pulmonary disease ^{(0, 1, 1, 0)}

0 (0%)

1 (1.6%)

1.0000

1 (2.2%)

2 (3.3%)

1.0000

Peripheral arterial disease ^{(1, 1, 1, 0)}

3 (10%)

1 (1.6%)

0.0965

0 (0%)

2 (3.3%)

0.5040

Cerebrovascular disease ^{(1, 1, 1, 0)}

3 (10%)

5 (8.2%)

0.7092

4 (8.7%)

5 (8.3%)

1.0000

Pain-to-door time (min) ^{(0, 2, 0, 1)}

1,855 (880, 5,732)

606 (388, 944)

< 0.0001

620 (255, 1,500)

349 (146, 659)

0.0141

Door-to-reperfusion time (min) ^{(5, 23, 4, 3)}

332 (182, 581)

194 (92, 329)

0.0371

76 (64, 113)

86 (56, 126)

0.9833

Number of diseased vessels ^{(0, 1, 0, 0)}

2 (2, 3)

2 (1, 3)

0.1857

2 (1, 3)

0.6462

Ejection fraction after PCI ^{(2, 3, 2, 2)}

42.5 (38, 49)

48 (40, 50)

0.1235

43 (35, 50)

40 (35, 45)

0.4401

Reperfusion strategy

0.1073

1.0000

Coronary artery bypass grafting surgery

2 (7%)

13 (21%)

2 (4%)

2 (3%)

PCI

25 (83%)

38 (61%)

44 (94%)

57 (95%)

Non-obstructive CAD

3 (10%)

11 (18%)

1 (2%)

Angiography access

0.0001

0.8034

Femoral

10 (33%)

7 (11%)

7 (15%)

10 (17%)

Right radial

16 (53%)

55 (89%)

40 (85%)

50 (83%)

Left proximal radial

4 (13%)

0 (0%)

Culprit vessel ^{(5, 23, 3, 3)}

0.3404

0.0319

Right coronary artery

4 (16%)

4 (10%)

12 (27%)

14 (25%)

Left main

2 (8%)

10 (26%)

1 (2.3%)

12 (21%)

Left anterior descending

10 (40%)

13 (33%)

26 (59%)

23 (40%)

Left circumflex

9 (36%)

12 (31%)

5 (11%)

8 (14%)

Right coronary dominance

26 (87%)

56 (90%)

0.7231

37 (79%)

56 (93%)

0.0261

**Table 2.** Outcomes of Patients Presenting With Acute Myocardial Infarction During (March 2020) and Before (March 2019) the COVID-19 Pandemic
Outcome	NSTEMI	STEMI
Superscripts indicate missing data in each of the four groups. STEMI: ST-segment elevation myocardial infarction; NSTEMI: non-ST-segment elevation myocardial infarction.
In-hospital hemorrhagic stroke ^{(1, 0, 0, 1)}	0 (0%)	0 (0%)	-	0 (0%)	0 (0%)	-
In-hospital ischemic stroke ^{(0, 0, 0, 1)}	0 (0%)	0 (0%)	-	1 (2.1%)	0 (0%)	0.4434
In-hospital cardiopulmonary resuscitation	2 (6.7%)	3 (4.8%)	0.6597	2 (4.3%)	4 (6.7%)	0.6930
Hypotension requiring vasopressors	4 (13%)	5 (8.1%)	0.4665	5 (10.6%)	6 (10%)	1.0000
Length of stay (days)	6 (5, 9)	5 (4, 7)	0.3138	6 (5, 8)	7 (5, 8.5)	0.3222
Inpatient death ^{(0, 0, 1, 0)}	2 (6.7%)	3 (4.8%)	0.6597	2 (4.3%)	4 (6.7%)	0.6955

Table 2. Outcomes of Patients Presenting With Acute Myocardial Infarction During (March 2020) and Before (March 2019) the COVID-19 Pandemic

Outcome

NSTEMI

STEMI

2020 (n = 30)

2019 (n = 62)

P value

2020 (n = 47)

2019 (n = 60)

P value

Superscripts indicate missing data in each of the four groups. STEMI: ST-segment elevation myocardial infarction; NSTEMI: non-ST-segment elevation myocardial infarction.

In-hospital hemorrhagic stroke ^{(1, 0, 0, 1)}

0 (0%)

In-hospital ischemic stroke ^{(0, 0, 0, 1)}

0 (0%)

1 (2.1%)

0 (0%)

0.4434

In-hospital cardiopulmonary resuscitation

2 (6.7%)

3 (4.8%)

0.6597

2 (4.3%)

4 (6.7%)

0.6930

Hypotension requiring vasopressors

4 (13%)

5 (8.1%)

0.4665

5 (10.6%)

6 (10%)

1.0000

Length of stay (days)

6 (5, 9)

5 (4, 7)

0.3138

6 (5, 8)

7 (5, 8.5)

0.3222

Inpatient death ^{(0, 0, 1, 0)}

2 (6.7%)

3 (4.8%)

0.6597

2 (4.3%)

4 (6.7%)

0.6955