61 The effect of covid-19 lockdown on stemi presentations: an early phase analysis

Introduction There is growing concern that public restrictions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) as well as patients’ concerns about developing the disease may be associated with delays in the presentation of ST elevation myocardial infarction (STEMI) with subsequent harmful effects on patient outcomes. In this study we sought to determine whether public restrictions implemented in the early phase of the COVID-19 lockdown was associated with any delay in patients presenting to medical attention and to assess for any associated difference in in-hospital mortality. STEMI patients were brought to the cardiac catheterisation laboratory and treated by healthcare workers utilising complete personal protective equipment (PPE). Therefore, we also aimed to determine if there was any increase in the cardiac catheterisation laboratory arrival to wire cross time. Methods This was a retrospective observational analysis of all STEMI patients presenting to University Hospital Limerick during the early phase of the COVID-19 lockdown from March 27, 2020 to April 17, 2020. These data were compared to a reference period of data from March 27, 2019 to April 17, 2019. The data are expressed as both means and medians, with 95% confidence intervals of the difference between means and estimated effect sizes also calculated. The Independent Samples t Test, Mann Whitney U Test and Fisher’s Exact Test were utilized as appropriate. Results The baseline demographics are demonstrated in table 1 and the outcomes of interest in table 2. The relative risk reduction of a patient presenting with STEMI during the lockdown as compared to the reference period was 36% (relative risk 0.64, 95% CI [0.36 to 1.15]). Total ischemic time was increased during the lockdown (1550 vs 485 minutes, difference between means 1066, 95% CI [16 to 2116], P=0.047). Patient delay appeared to be the most important factor leading to the increased total ischemic time. This was validated by the increase in the duration from symptom onset to first medical contact (1450 vs 323 minutes, difference between means 1127, 95% CI [74 to 2180], P=0.037). There was no significant difference in cath lab arrival to wire cross time (19 vs 18 minutes, difference between means 0.9, 95% CI [-10 to 12] P=0.87). Numerically more patients presented greater than 24 hours after the onset of chest pain in the COVID-19 lockdown group (3 [33%] vs 1 [7%], P=0.1) with a numerically higher in-hospital mortality during this period which nearly met statistical significance (2 [22%] vs 0 [0%], P=0.06). Conclusion/Implications This study suggests that the early phase of the COVID-19 lockdown was associated with a delay in patients seeking medical attention for STEMI. We would suggest that emphasis should be placed at a national level to inform the public that life-saving interventions such as 24/7 PPCI are still available during lockdown.