During COVID-19 pandemic, a critical issue for cardiologists was to provide early access to the standard of care for patients with time-dependent diseases such as ST-segment elevation myocardial infarction (STEMI), while making efforts to prevent their exposure to SARS CoV-2.
Aims: The aim of our research project was to evaluate the role of an Emergency Department-based operative unit directly managed by the Cardiology Department in providing a prompt cardiological evaluation to STEMI patients at first medical contact, which we assumed might positively impact on the reperfusion strategy and timing and thus on the extent of myocardial salvage.
Methods: We retrospectively included a group of STEMI patients admitted by our ED with a definitive diagnosis of STEMI from March 2020 to November 2021 and a control group admitted from January 2019 to February 2020. The groups were compared in terms of critical time intervals, rate of PCI or initial non-invasive conservative management, pre-discharge characteristics and in-hospital clinical outcomes, including all cause mortality and complications.
Results: Throughout the study period, a total of 211 patients were admitted to our institution with a diagnosis of STEMI. The number of patients presenting late (at least twelve hours since symptoms onset) was significantly higher and time from symptoms onset to hospital admission was significantly longer during the first COVID-19 pandemic peak, compared with the previous year. Almost all patients in both cohorts underwent invasive coronary angiography with subsequent primary PCI. Remarkably, despite the time-consuming hygiene practices and policies necessary to prevent patients’ exposure to SARS CoV-2 virus, door-to-balloon time was comparable between the two cohorts. No statistically significant differences were found regarding the occurrence of STEMI-related complications. The in-hospital mortality was comparable between the two cohorts, as was predischarge LVEF. The high-sensitivity Troponin-T peak was significantly lower after the introduction of the ED-based cardiology unit. Total in-hospital stay was shorter after the introduction of the ED cardiology unit.
Conclusions: Our experience has shed light on the potential advantages of an ED-based unit directly managed by the Cardiology Department: despite the confirmation of a longer time from symptoms onset to hospital admission, no significant differences were found in terms of hard outcomes between the groups.