Peripandemic Impact of the First Wave of COVID-19 Pandemic on Management and Prognosis of ST-Segment Elevation Myocardial Infarction in China

Background: Rapid reperfusion of ST-segment elevation myocardial infarction (STEMI) has been challenged during the coronavirus disease 2019 (COVID-19) outbreak. Whether and to what degree the residual impact existed when the COVID-19 pandemic is appeased are unclear.Methods: This nationwide retrospective study was based on electronic records of STEMI patients registered between October 23, 2019, and July 22, 2020 in Chinese Cardiovascular Association Database-Chest Pain Centers in China. We analyzed 141,375 STEMI patients (including 4,871 patients in Hubei province where 80% of COVID-19 cases in China occurred in 2019-2020) who were registered during the COVID-19 pre-outbreak period (October 23, 2019 to January 22, 2020), the outbreak period (January 23 to April 22, 2020), and post-outbreak period (April 23 to July 22, 2020).Findings: In the post-outbreak period in Hubei province, the increased in-hospital mortality of STEMI patients dropped to be insignificant (adjusted odds ratio compared to the pre-outbreak level (aOR) 1·40, [95% confidential interval (CI): 0·97-2·03]) and was lower than that in the outbreak period (1·62 [1·09-2·41]); the decreased odds of primary percutaneous coronary intervention (PCI) (0·73 [0·55-0·96]) and timely reperfusion (0·74 [0·62-0·88]) still existed though they were substantially improved than that in the outbreak period (aOR of primary PCI: 0·23 [0·18-0·30] and that of timely reperfusion: 0·43 [0·35-0·53]). In the post-outbreak period in non-Hubei provinces, the impact of the COVID-19 pandemic on STEMI management and prognosis was weakened to be insignificant.Interpretation: Our findings revealed the residual pandemic impacts on STEMI management existed three months after the COVID-19 outbreak in Hubei province. Such residual impacts indicate a timely adoption of countermeasures is crucial to avoid long-standing adverse social effects.Funding: National Natural Science Foundation of China, Shanghai Clinical Research Center for Interventional Medicine, Shanghai ‘Rising Stars of Medical Talent’ Youth Development Program, Key Clinical Research Projects of National Clinical Research Center for Interventional Medicine.Declaration of Interest: No author has a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of this studyEthical Approval: This study was approved by the Ethics Committee of Zhongshan Hospital affiliated to Fudan University. The requirement for informed consent was waived due to the observational nature of the study and the de-identified nature of the data