Table_1_Outcomes and mechanical complications of acute myocardial infarction during the second wave pandemic in a Milan HUB center for cardiac emergencies.pdf

AimsCOVID-19 has dramatically impacted the healthcare system. Evidence from previous studies suggests a decline in in-hospital admissions for acute myocardial infarction (AMI) during the pandemic. However, the effect of the pandemic on mechanical complications (MC) in acute ST-segment elevation myocardial infarction (STEMI) has not been comprehensively investigated. Therefore, we evaluated the impact of the pandemic on MC and in-hospital outcomes in STEMI during the second wave, in which there was a huge SARS-CoV-2 diffusion in Italy.
Methods and resultsBased on a single center cohort of AMI patients admitted with STEMI between February 1, 2019, and February 28, 2021, we compared the characteristics and outcomes of STEMI patients treated during the pandemic vs. those treated before the pandemic. In total, 479 STEMI patients were included, of which 64.5% were during the pandemic. Relative to before the pandemic, primary percutaneous coronary intervention (PCI) declined (87.7 vs. 94.7%, p = 0.014) during the pandemic. Compared to those admitted before the pandemic (10/2019 to 2/2020), STEMI patients admitted during the second wave (10/2020 to 2/2021) presented with a symptom onset-to-door time greater than 24 h (26.1 vs. 10.3%, p = 0.009) and a reduction of primary PCI (85.2 vs. 97.1%, p = 0.009). MC occurred more often in patients admitted during the second wave of the pandemic than in those admitted before the pandemic (7.0 vs. 0.0%, p = 0.032). In-hospital mortality increased during the second wave (10.6 vs. 2.9%, p = 0.058).
ConclusionAlthough the experience gained during the first wave and a more advanced hub-and-spoke system for cardiovascular emergencies persists, late hospitalizations and a high incidence of mechanical complications in STEMI were observed even in the second wave.

## 研究目的
新型冠状病毒肺炎（COVID-19）对全球医疗体系造成了剧烈冲击。既往研究证据显示，疫情期间因急性心肌梗死（acute myocardial infarction, AMI）收治的住院患者数量有所下降。然而，目前尚未有研究全面探讨疫情对ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者机械并发症（mechanical complications, MC）的影响。因此，本研究针对意大利出现新型冠状病毒（SARS-CoV-2）大规模传播的第二波疫情，评估其对STEMI患者机械并发症及院内结局的影响。

## 研究方法与结果
本研究基于2019年2月1日至2021年2月28日期间收治的STEMI患者单中心队列，对比了疫情期间与疫情前接受治疗的STEMI患者的临床特征及结局。本研究共纳入479例STEMI患者，其中64.5%的病例来自疫情期间。与疫情前相比，疫情期间患者的直接经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）率有所下降（87.7% vs 94.7%，p=0.014）。相较于疫情前收治的患者（2019年10月至2020年2月），第二波疫情期间收治的STEMI患者（2020年10月至2021年2月）中，症状发作至入院时间超过24小时的比例更高（26.1% vs 10.3%，p=0.009），且直接PCI率更低（85.2% vs 97.1%，p=0.009）。第二波疫情期间收治的患者机械并发症发生率显著高于疫情前（7.0% vs 0.0%，p=0.032）。第二波疫情期间患者的院内死亡率有所升高（10.6% vs 2.9%，p=0.058）。

## 研究结论
尽管第一波疫情期间积累的临床经验以及更为完善的心血管急诊枢纽-分支医疗体系仍在发挥作用，但在第二波疫情期间，STEMI患者仍出现了就诊延迟及机械并发症高发的情况。