Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment–Elevation Myocardial Infarction Care in Hong Kong, China

Abstract

A cute ST-segment-elevation myocardial infarction (STEMI) is a disease of high mortality and morbidity, and primary percutaneous coronary intervention (PPCI) is the typical recommended therapy.1,2 Systems of care have been established to expedite PPCI workflow to minimize ischemic time from symptom onset to definitive treatment in the catheterization laboratory.Little is known about the impact of public health emergencies like a community outbreak of infectious disease on STEMI systems of care.Since December 2019, the emergence of Coronavirus disease 2019 (COVID-19) in Wuhan, China, has evolved into a regional epidemic, including in Hong Kong, a city in Southern China.We describe the impact of the COVID-19 outbreak on STEMI care in Hong Kong through a handful of recent cases of patients with STEMI who underwent PPCI at a single center.We included patients with STEMI admitted via the Accident and Emergency Department and in whom PPCI was performed.We focus on the time period since January 25, 2020, when hospitals in the city started to institute emergency infection protocols to contain COVID-19.This required hospitals to suspend all nonessential visits and adjust clinical in-patient and out-patient services.Indications for PPCI were according to the international guidelines.1,2 Study exclusion criteria included inpatient STEMI (n=1), STEMI with unknown symptom onset time (n=3), and cardiac arrest patients (n=2).Our hospital has offered 24/7 PPCI service to all eligible patients presenting with acute STEMI since 2010 per standard Accident and Emergency Department protocol.When STEMI is diagnosed, a PPCI team is activated after cardiology evaluation.Data on key time points in STEMI care are recorded in a clinical registry.Symptom-onset-to-first-medicalcontact time is defined as the time from patient-reported chest discomfort onset time to the time of first medical contact.Door-to-device time is defined as the time from Accident and Emergency Department arrival to successful wire crossing time during PPCI.Catheterization laboratory arrival-to-device time is defined as the time from patient arrival in the catheterization laboratory to successful wire crossing time.From January 25, 2020, to February 10, 2020, we observed changes in time components of STEMI care among the aggregate group of 7 consecutive patients who underwent PPCI.We compared these with data from 108 patients with STEMI treated with PPCI in the prior year from February 1, 2018, to January 31, 2019 (N=108).These 7 patients did not suffer from COVID-19 infection, and 6 out of 7 presented to our hospital during regular work hours (8 am-8 pm weekdays, excluding public holidays).The Table shows numerically longer median times in all components when compared with historical data from the prior year.The largest time difference was in the time from symptom onset to first medical contact.