key: cord-0780059-3mofbyef
authors: Tam, Chor‐Cheung Frankie; Cheung, Kent‐Shek; Lam, Simon; Wong, Anthony; Yung, Arthur; Sze, Michael; Fang, Jonathan; Tse, Hung‐Fat; Siu, Chung‐Wah
title: Impact of coronavirus disease 2019 (COVID‐19) outbreak on outcome of myocardial infarction in Hong Kong, China
date: 2020-05-05
journal: Catheter Cardiovasc Interv
DOI: 10.1002/ccd.28943
sha: 0c8d3df04e89541e122e8df9af70e3163d7b85ec
doc_id: 780059
cord_uid: 3mofbyef

OBJECTIVE: To determine whether COVID‐19 may adversely affect outcome of myocardial infarction (MI) patients in Hong Kong, China. BACKGROUND: The COVID‐19 pandemic has infected thousands of people and placed enormous stress on healthcare system. Apart from being an infectious disease, it may affect human behavior and healthcare resource allocation which potentially cause treatment delay in MI. METHODS: This was a single center cross‐sectional observational study. From November 1, 2019 to March 31, 2020, we compared outcome of patients admitted for acute ST‐elevation MI (STEMI) and non‐ST elevation MI (NSTEMI) before (group 1) and after (group 2) January 25, 2020 which was the date when Hong Kong hospitals launched emergency response measures to combat COVID‐19. RESULTS: There was a reduction in daily emergency room attendance since January 25, 2020 (group 1,327/day vs. group 2,231/day) and 149 patients with diagnosis of MI were included into analysis (group 1 N = 85 vs. group 2 N = 64). For STEMI, patients in group 2 tended to have longer symptom‐to‐first medical contact time and more presented out of revascularization window (group 1 27.8 vs. group 2 33%). The primary composite outcome of in‐hospital death, cardiogenic shock, sustained ventricular tachycardia or fibrillation (VT/VF) and use of mechanical circulatory support (MCS) was significantly worse in group 2 (14.1 vs. 29.7%, p = .02). CONCLUSIONS: More MI patients during COVID‐19 outbreak had complicated in‐hospital course and worse outcomes. Besides direct infectious complications, cardiology community has to acknowledge the indirect effect of communicable disease on our patients and system of care.

Since December 2019, the emergence of coronavirus disease in Wuhan, China has been spreading quickly and evolved into a pandemic. 1 As of early April 2020, COVID-19 has infected more than 1.5 million people and killed more than 90,000. COVID-19 is a viral infection causing respiratory system involvement 2 and its highly infectious nature mandates healthcare system to implement strict infection control measures to limit its virulence. Unprecedentedly, COVID-19 place huge burden on every part of healthcare system directly and indirectly. Hong Kong, as a city in southern part of China, started to have imported cases in January followed by community outbreak swiftly afterwards. As a result, hospitals in Hong Kong launched the emergency response measures on January 25, 2020 to combat the outbreak. Previously, our group demonstrated that COVID-19 could affect human behavior and healthcare resource allocation which led to treatment delay in acute myocardial infarction (MI). 3 We sought to investigate the impact of current COVID-19 outbreak on MI outcome in our patients in Hong Kong.

This was a single center cross-sectional observational study of a hospital-based registry. We included all patients with a diagnosis of acute ST-elevation MI (STEMI) or non-ST elevation MI (NSTEMI) presented to Accident and Emergency Department (AED) from November 1, 2019 to March 31, 2020 into analysis. We compared the characteristics and outcome of MI patients before and after January 25, 2020. Outcome of myocardial infarction patients before and after COVID-19 response activation on January 25, 2020 

From November 1, 2019 to March 31, 2020, there was a marked decrease in AED attendance (Table 1) 

WHO declares COVID-19 a pandemic

Clinical characteristics of coronavirus disease 2019 in China

Impact of coronavirus disease 2019 (COVID-19) outbreak on ST-segment-elevation myocardial infarction care in Hong Kong

Fourth universal definition of myocardial infarction

AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association task force on practice guidelines

ESC guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the Management of Acute Coronary Syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC)

Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong

Matthew TSUI and all healthcare workers sacrifice themselves in current COVID-19 outbreak. This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

The authors declare no conflict of interest in relationship with manuscript content.

https://orcid.org/0000-0003-4159-7635Kent-Shek Cheung https://orcid.org/0000-0002-0995-4623