Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Admitted During COVID-19 Pandemic Lockdown in Germany - Results of a Single Center Prospective Cohort Study

Manuel Rattka; Lina Stuhler; Claudia Winsauer; Jens Dreyhaupt; Kevin Thiessen; Michael Baumhardt; Sinisa Markovic; Wolfgang Rottbauer; Armin Imhof

doi:10.3389/fcvm.2021.638954

Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Admitted During COVID-19 Pandemic Lockdown in Germany - Results of a Single Center Prospective Cohort Study

Front Cardiovasc Med. 2021 Apr 20:8:638954. doi: 10.3389/fcvm.2021.638954. eCollection 2021.

Authors

Manuel Rattka¹, Lina Stuhler¹, Claudia Winsauer¹, Jens Dreyhaupt², Kevin Thiessen¹, Michael Baumhardt¹, Sinisa Markovic¹, Wolfgang Rottbauer¹, Armin Imhof¹

Affiliations

¹ Clinic for Internal Medicine II, University Hospital Ulm - Medical Center, Ulm, Germany.
² Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.

Abstract

Objective: Since the outbreak of the COVID-19 pandemic, healthcare professionals reported declining numbers of patients admitted with ST-segment myocardial infarction (STEMI) associated with increased in-hospital morbidity and mortality. However, the effect of lockdown on outcomes of STEMI patients admitted during the COVID-19 crisis has not been prospectively evaluated. Methods: A prospective, observational study on STEMI patients admitted to our tertiary care center during the COVID-19 pandemic was conducted. Outcomes of patients admitted during lockdown were compared to those patients admitted before and after pandemic-related lockdown. Results: A total of 147 patients were enrolled in our study, including 57 patients in the pre-lockdown group (November 1, 2019 to March 20, 2020), 16 patients in the lockdown group (March 21 to April 19, 2020), and 74 patients in the post-lockdown group (April 20 to September 30, 2020). Patients admitted during lockdown had significantly longer time to first medical contact, longer door-to-needle-time, higher serum troponin T levels, worse left ventricular end-diastolic pressure, and higher need for circulatory support. After a median follow-up of 142 days, survival was significantly worse in STEMI patients of the lockdown group (log-rank: p = 0.0035). Conclusions: This is the first prospective study on outcomes of STEMI patients admitted during public lockdown amid the COVID-19 pandemic. Our results suggest that lockdown might deteriorate outcomes of STEMI patients. Public health strategies to constrain spread of COVID-19, such as lockdown, have to be accompanied by distinct public instructions to ensure timely medical care in acute diseases such as STEMI.

Keywords: COVID-19; Germany; STEMI; epidemiology; lockdown; myocardial infarction; outcome.