Assessment of ST-Segment Elevation Myocardial Infarction Volume Trends During The COVID-19 Pandemic.

Routine inpatient and outpatient health care has been greatly disrupted by the COVID-19 pandemic and both equipment and personnel have been redeployed in order to manage the crisis (https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental). There have been anecdotal accounts (https://www.nytimes.com/2020/04/06/well/live/coronavirus-doctors-hospitals-emergency-care-heart-attack-stroke.html) and a publication discussing the decrease in the number of ST-segment elevation myocardial infarction (STEMI) activiations. One explanation proposed for the decrease includes patients not seeking medical attention for ischemic symptoms due to fear of becoming infected by the coronavirus or presenting to the hospital late in their STEMI course.

Massachusetts ranks third in total number of COVID-19 cases and fourth in total number of COVID-19 deaths in the United States. (https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html) To determine if there has been a decrease in STEMI volume during the COVID-19 timespan (Figure 1 a), we analyzed our January through April 2020 STEMI volume in comparison to January through April 2018 and 2019 (Figure 1b). We also analyzed STEMI volume for March 15 through April 15, 2018 and 19 in comparison to 2020 (Figure 1c). Baystate Medical Center is a tertiary hospital located in Western Massachusetts serving more than 10 referral hospitals with >350 STEMI cases per year. The STEMI volume includes patients presenting to Baystate Medical Center and transfers from referral centers.

Figure 1

(1a) Timeline of the COVID-19 pandemic in the United States and Massachusetts. (1b) ST STEMI volume January through April 2020 compared to January through April 2018 and 2019. (1c) STEMI volume for March 15 through April 15, 2020 compared to March 15 through April 15, 2018 and 2019.

Our preliminary analysis during the early phase of the pandemic demonstrates no significant reduction in STEMI volume during the COVID-19 pandemic. One difference between Garcia et al. and our findings is the fact that we evaluated STEMI volume rather than STEMI activations. STEMI activations during the COVID-19 pandemic could be reduced due to the fact that emergency department personnel, due to concerns for infection, may consult interventional cardiology directly rather than activate the cardiac catheterization laboratory in order to limit exposure and decrease false activation.

In conclusion, in a high-volume STEMI center in the Commonwealth of Massachusetts, with high volumes of reported COVID-19 cases, there was no significant change in STEMI volume during the COVID-19 timespan.