Who has seen ST-segment elevation myocardial infarction patients? First results from Italian real world COVID-19.

Background After the Coronavirus Virus Disease 2019 (COVID-19) outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment elevation myocardial infarction (STEMI) care during the COVID-19 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention (PCI). Methods and Results Consecutive patients affected by STEMI from 1 to 31 March 2020, during social restrictions of Italian Government, were collected and compared with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of STEMI patients who were admitted to our catheterization laboratory, when compared to the same period of 2019 (13 vs. 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the two groups, while the length of hospitalization was longer in patients of 2020. In this group we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions COVID-19 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers and worse left ventricular function.