Outcomes of STEMI Patients in COVID-19 Pandemic: A  Systematic Review and Meta-Analysis

Shiva  Khaleghparast; Majid  Maleki; Fereidoun  Noohi; Mahmood Sheikh Fathollah; Yasaman  Khalili; Yeganeh  Pasebani; Farnaz  Rafiee; Fahimeh  Farrokhzadeh; Sajjad  Biglari; Saeideh  Mazloomzadeh

doi:10.18502/ijph.v53i9.16451

Shiva Khaleghparast Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Majid Maleki Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Fereidoun Noohi Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Mahmood Sheikh Fathollah Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Yasaman Khalili Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Yeganeh Pasebani Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Farnaz Rafiee Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Fahimeh Farrokhzadeh Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
Sajjad Biglari Maastricht University Medical Center MUMC+, Department of Clinical Genetics, Maastricht, The Nederland
Saeideh Mazloomzadeh Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijph.v53i9.16451

Keywords: COVID-19; ST elevation myocardial infarction; Door to balloon; Mortality

Abstract

Background: The global SARS-CoV-2 pandemic has disrupted health systems and put a huge strain on hospitals and healthcare workers. Prioritizing COVID-19 patients in hospitals caused irreversible harm to cardiac patients. Although multiple studies have shown that ST-segment elevation myocardial infarction (STEMI) patients have worse admission circumstances than before the pandemic, the hospital outcomes of these patients have remained limited. This systematic review and meta-analysis examined STEMI patient outcomes during the COVID-19 epidemic.

Methods: We conducted systematic searches of MEDLINE (through PubMed), Web of Science, Scopus, and Embase through Jan 10, 2021. All studies with reporting in-hospital mortality, length of stay, and door-to-balloon time with over twenty participants were included. Articles without clear definitions or results were excluded. The study followed PRISMA guidelines. The outcomes of interest were door-to-balloon time, death, and hospital stay during COVID-19 pandemic compared prior.

Results: Our meta-analysis included 12 studies and 21170 people (115-6609). The pooled analysis showed significantly more pandemic mortality (OR=1.24; 95% CI: 1.07-1.43). Ten studies (13,091) recorded door-to-balloon times. Door-to-balloon time (in minutes) significantly increased during the pandemic (Standardized Mean Difference [SMD]= 0.46; 95% CI: 0.03-0.89). The length of hospital stay was reported by five studies (n=9448). Length of hospital stay (in days) was not significantly longer during the pandemic than before the outbreak (SMD= 0.04; 95% CI: -0.19-0.26).

Conclusion: The COVID-19 pandemic is associated with increased mortality and door-to-balloon delay that might be attributable to the strict infection control measures in outbreak. Studies with a longer follow-up time are needed to investigate the outcomes of STEMI patients.