ST-elevation Myocardial Infarction (STEMI) Presentations During Lockdown for Coronavirus Disease 2019 (COVID-19)

We assessed the impact of the first lockdown related to the coronavirus disease 2019 (COVID-19) pandemic on cardiac presentations at our local institution. We hypothesised that there was a reduction and delay in ST-elevation myocardial infarction (STEMI) presentations and management. Observational study. Single tertiary hospital in Sydney, Australia. All cardiac catheterisation laboratory (CCL) activations for suspected STEMI “pre-COVID” (1st January to 31st December 2019, n=129) and “post-COVID” (15th March to 31st May 2020, n=18). Number of STEMI CCL activations, symptom-to-door time, door-to-device time, and in-hospital mortality rate. There was a 34.7% reduction in STEMI CCL activations post-COVID compared with pre-COVID, which did not reach statistical significance (1.62/week; 95% CI 1.02–2.26 versus 2.48/week; 95% CI 2.04–2.92, p=0.09). There was a significant delay in median symptom-to-door time of 150 minutes; 255 minutes post-COVID, interquartile range (IQR) 108-2955 versus 105 minutes, IQR 60-417 pre-COVID, p=0.02. Although not statistically significant door-to-device time was longer by 23 minutes, 92 minutes post-COVID versus 69 minutes pre-COVID, p=0.24 and in-hospital mortality was more than 3-fold higher post-COVID (pre-COVID; 4.7% (6/129) versus post-COVID; 16.7% (3/18) p=0.08). Our data suggest a reduction in STEMI presentations similar in magnitude to those reported in areas with a high prevalence of COVID-19. Furthermore, there was a significant delay in presentation post symptom-onset. Further research into the causes of this avoidance phenomenon may help to guide public health campaigns and effective system changes to avoid unintended poor health consequences during the COVID-19 pandemic.