Challenges in managing ST elevation myocardial infarction during the COVID-19 pandemic

Table 1 Characteristics and outcomes of patients presenting with ST elevation myocardial infarction during March-August 2019 (2019 Match Group) and March-August 2020 (coronavirus disease group)

	2019 Match		2020 COVID		P value
Patient characteristics
Age (yr), mean ± SE	n = 52	60.23 + 1.77	n = 48	62.73 + 1.80	0.45
Females, n (%)	n = 52	43 (82.7)	n = 48	33 (68.8)	0.10
Comorbidities, mean ± SE	n = 47	2.67 ± 0.22	n = 44	2.74 ± 0.22	0.83
Hypertension, n (%)	n = 52	36 (69.2)	n = 48	35 (72.9)
Hyperlipidemia, n (%)	n = 52	30 (57.7)	n = 48	28 (58.3)
Diabetes, n (%)	n = 52	14 (26.9)	n = 48	18 (37.5)
Coronary artery disease, n (%)	n = 52	21 (40.4)	n = 48	15 (31.3)
Obesity, n (%)	n = 52	15 (28.8)	n = 48	19 (39.6)
Smoking, n (%)	n = 47	20 (42.6)	n = 44	19 (43.2)
Killip score (mean ± SE), n (%)	n = 52	1.10 ± 0.08	n = 48	1.27 ± 0.13	0.25
0		1 (1.9)		1 (2.1)
1		49 (94.2)		42 (87.5)
2		0 (0.0)		0 (0.00)
3		0 (0.0)		1 (2.1)
4		2 (3.9)		4 (8.3)
Initial troponin level (ng/mL), mean ± SE	n = 43	2.22 ± 0.98	n = 45	2.38 ± 1.52	0.88
Peak troponin level (ng/mL), mean ± SE	n = 47	47.75 ± 7.07	n = 42	74.31 ± 14.25	0.20
Ejection fraction < 40, relative risk				1.99
n (%)	n = 52	5 (9.6)	n = 47	9 (19.1)	0.17
Location and vessel involvement
Location	n = 51		n = 48
Anterior/anteroseptal, n (%)		11 (21.6)		16 (33.3)
Anterolateral, n (%)		2 (3.9)		3 (6.2)
Inferior/inferoposterior, n (%)		33 (64.7)		20 (41.7)
Lateral, n (%)		5 (9.8)		9 (18.7)
Culprit vessel, n (%)	n = 51		n = 48		0.28
LM		0		0
RCA		31 (60.8)		22 (45.8)
LAD		13 (25.5)		19 (39.6)
LCx		7 (13.7)		7 (14.6)
Non-culprit vessel stenosis ≥ 50%, n (%)	n = 32		n = 32
RCA		7 (33.3)	n = 26	16 (61.5)	0.05
LAD		18 (47.4)	n = 29	17 (58.6)	0.36
LCx		16 (36.4)	n = 41	18 (43.9)	0.48
Patient outcomes
Symptom onset to FMC (min), mean ± SE	n = 41	189.71 ± 70.18	n = 44	530.00 ± 143.53	0.02
Time to EKG (min), mean ± SE	n = 38	7.66 ± 2.31	n = 35	8.26 ± 2.54	0.81
Door to balloon (min), mean ± SE	n = 50	56.78 ± 5.65	n = 46	53.67 ± 3.43	0.73
FMC to balloon (min), mean ± SE	n = 50	89.14 ± 5.55	n = 42	90.02 ± 6.49	0.99
Hospital LOS (days), mean ± SE	n = 52	4.40 ± 0.88	n = 47	4.57 ± 0.50	0.87
Cardiogenic shock, relative risk				1.81
n (%)	n = 52	3 (5.8)	n = 48	5 (10.4)	0.23
In-hospital MACE (death, MI, cardiac arrest, stroke), relative risk				2.49
n (%)	n = 52	8 (15.4)	n = 47	18 (38.3)	0.01
MACE < 14 d from admission, relative risk				3.03
n (%)	n = 52	8 (15.4)	n = 45	21 (46.7)	< 0.001

SE: Standard error; LM: Left main; RCA: Right coronary artery; LAD: Left anterior descending; LCx: Left circumflex; FMC: First medical contact; EKG: Electrocardiogram; MACE: Major adverse cardiac events; LOS: Length of stay; COVID: Coronavirus disease.