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Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction.

  • Choi, Hyohun1
  • Lee, Jang Hoon1, 2
  • Park, Hyuk Kyoon1
  • Lee, Eunkyu1
  • Kim, Myeong Seop1
  • Kim, Hyeon Jeong1
  • Park, Bo Eun1
  • Kim, Hong Nyun1, 3
  • Kim, Namkyun1, 3
  • Jang, Se Yong1, 3
  • Bae, Myung Hwan1, 3
  • Yang, Dong Heon1, 3
  • Park, Hun Sik1, 3
  • Cho, Yongkeun1, 3
  • 1 Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea. , (North Korea)
  • 2 School of Medicine, Kyungpook National University, Daegu, Korea. [email protected] , (North Korea)
  • 3 School of Medicine, Kyungpook National University, Daegu, Korea. , (North Korea)
Published Article
Journal of Korean medical science
Publication Date
May 30, 2022
DOI: 10.3346/jkms.2022.37.e167
PMID: 35638194


It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior. A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death. There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic. During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea. © 2022 The Korean Academy of Medical Sciences.

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