PDF(Pubmed)
Abstract：
BACKGROUND: During COVID-19 pandemic, the emergency department (ED) was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period.
METHODS: This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center\'s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality.
RESULTS: Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms.
CONCLUSIONS: In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.
METHODS: This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center\'s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality.
RESULTS: Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms.
CONCLUSIONS: In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.
摘要：
背景：在COVID-19大流行期间，急诊科(ED)在治疗有COVID-19相关症状的患者方面面临挑战.因此,本研究的目的是调查ST段抬高型心肌梗死(STEMI)患者在因隔离或预防措施导致的COVID-19大流行期间的治疗延迟和预后结局,并与COVID-19前期进行比较.
方法：这是一项回顾性观察研究，使用不同病例组合的多中心数据。通过各中心普通病例报告表的电子医疗数据收集匿名数据。主要结果是28天内住院死亡率的数量和比率。次要结果是门到气球的时间和在ED中的停留时间。进行Kaplan-Meier估计和Cox比例风险回归分析以确定预测因子对28天住院死亡率的影响。
结果：在COVID-19期间，有COVID-19相关症状的STEMI患者的门至球囊时间比没有症状的患者长（97.0[74.8，139.8]与69.0[55.0,102.0]分钟,P<.001)。然而,在COVID-19前期，有和没有COVID-19相关症状的STEMI患者的门到球囊时间没有显着统计学差异（73.0[61.0，92.0]vs.67.0[54.5,80.0]分钟,P=.2869）。根据COVID-19前期提示COVID-19的症状，28天死亡率没有显示出统计学上的显著差异(15.4%vs.6.8%,P=.1257）。然而,在COVID-19期间，这一比例明显更高(21.1%与6.7%,P=.0102），有COVID-19提示症状的患者比没有症状的患者。
结论：在韩国，大流行期间提示COVID-19的症状对STEMI患者的门至球囊时间增加和28日死亡率有显著影响.因此，卫生当局需要根据各种医学领域专家的意见，在指定ED中指示隔离的症状时做出谨慎的决定。
方法：这是一项回顾性观察研究，使用不同病例组合的多中心数据。通过各中心普通病例报告表的电子医疗数据收集匿名数据。主要结果是28天内住院死亡率的数量和比率。次要结果是门到气球的时间和在ED中的停留时间。进行Kaplan-Meier估计和Cox比例风险回归分析以确定预测因子对28天住院死亡率的影响。
结果：在COVID-19期间，有COVID-19相关症状的STEMI患者的门至球囊时间比没有症状的患者长（97.0[74.8，139.8]与69.0[55.0,102.0]分钟,P<.001)。然而,在COVID-19前期，有和没有COVID-19相关症状的STEMI患者的门到球囊时间没有显着统计学差异（73.0[61.0，92.0]vs.67.0[54.5,80.0]分钟,P=.2869）。根据COVID-19前期提示COVID-19的症状，28天死亡率没有显示出统计学上的显著差异(15.4%vs.6.8%,P=.1257）。然而,在COVID-19期间，这一比例明显更高(21.1%与6.7%,P=.0102），有COVID-19提示症状的患者比没有症状的患者。
结论：在韩国，大流行期间提示COVID-19的症状对STEMI患者的门至球囊时间增加和28日死亡率有显著影响.因此，卫生当局需要根据各种医学领域专家的意见，在指定ED中指示隔离的症状时做出谨慎的决定。
