COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction

H.N. Sturkenboom*, V.A.E. van Hattem, W. Nieuwland, F.M.A. Paris, M. Magro, R.L. Anthonio, A. Algin, E. Lipsic, E. Bruwiere, B.J.L. Van den Branden, J. Polad, P. Tonino, R.A. Tio

*Corresponding author for this work

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Background The current study aimed to evaluate changes in treatment delay and outcome for ST-segment elevation myocardial infarction (STEMI) in the Netherlands during the first coronavirus disease 2019 (COVID-19) outbreak, thereby comparing regions with a high and low COVID-19 hospitalisation rate. Methods Clinical characteristics, STEMI timing variables, 30-day all-cause mortality and cardiovascular complications of all consecutive patients admitted for STEMI from 1 January to 30 June in 2020 and 2019 to six hospitals performing a high volume of percutaneous coronary interventions were collected retrospectively using data from the Netherlands Heart Registry, hospital records and ambulance report forms. Patient delay, pre-hospital delay and door-to-balloon time before and after the outbreak of COVID-19 were compared to the equivalent periods in 2019. Results A total of 2169 patients were included. During the outbreak median total treatment delay significantly increased (2 h 51 min vs 2 h 32 min; p = 0.043) due to an increased patient delay (1 h 20 min vs 1 h; p = 0.030) with more late presentations > 24 h (1.1% vs 0.3%) in 2020. This increase was particularly evident during the peak phase of COVID-19 in regions with a high COVID-19 hospitalisation rate. During the peak phase door-to-balloon time was shorter (38 min vs 43 min; p = 0.042) than in 2019. All-cause 30-day mortality was comparable in both time frames (7.8% vs 7.3%; p = 0.797). Conclusions During the outbreak of COVID-19 patient delay caused an increase in total ischaemic time for STEMI, with a more pronounced delay in high-endemic regions, stressing the importance of good patient education during comparable crisis situations.
Original languageEnglish
Pages (from-to)96-105
Number of pages10
JournalNetherlands Heart Journal
Issue number2
Publication statusPublished - 1 Feb 2022


  • ST-segment myocardial infarction
  • COVID-19
  • Percutaneous coronary intervention
  • Treatment delay
  • Door-to-balloon time

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