Evidence map›Paper›PMID 33521615›Full record

ArticleCJC open2020

Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study.

Cole R Clifford, Michel Le May, Alyssa Chow, Rene Boudreau, Angel Y N Fu, Quinton Barry, Aun Yeong Chong, Derek Y F So

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in CJC open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 3 pooled it
1.9field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 34 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Cole R CliffordDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Michel Le MayDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Alyssa ChowDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Rene BoudreauDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Angel Y N FuDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Quinton BarryDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Aun Yeong ChongDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Derek Y F SoDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
University of Ottawa · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundManagement of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have impacted STEMI management. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system.

methods494 patients with STEMI were grouped into pre-lockdown, lockdown and re-opening cohorts. Clinical, temporal and outcome data were collected and compared between groups for both urban and rural patients, receiving primary percutaneous coronary intervention (PCI) and pharmacoinvasive revascularization, respectively. Data was compared to a 10-year historical comparator.

resultsDuring pre-lockdown there was 238 cases versus 193 in lockdown; a 19.0% reduction in volume. When lockdown was compared to the median caseload from a 10-year historical cohort, a 19.8% reduction was observed. For patients treated with primary PCI during lockdown, median symptom-to-balloon time increased by 44-minutes [217 (IQR 157-387) vs. 261 (160-659) minutes; p=0.03]; driven by an increase in median symptom-to-door time of 41-minutes [136 (IQR 80-267) vs. 177 (IQR 90-569) minutes; p<0.01]. Only patients transferred from non-PCI facilities demonstrated an increase in door-to-reperfusion time [116 (IQR 93-150) vs. 139 (IQR 100-199) minutes; p<0.01]. More patients had left ventricular dysfunction during the lockdown [35% vs. 44%; p=0.04], but there was no difference in mortality.

conclusionDuring the COVID-19 lockdown, fewer patients presented with STEMI. Time-to-reperfusion was significantly prolonged and appeared driven predominantly by patient-level and transfer delays. Public education and systems-level changes will be integral to STEMI care during the second wave of COVID-19.

Identifiers

PMID33521615
PMCPMC7834324
OpenAlexW3112823178

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.