Prehospital ECG in patients with acute myocardial infarction during the COVID-19 pandemic. (14th October 2021)

• Record Type: Journal Article
• Authors: Avvedimento, M; Leone, A; Spinelli, A; Franzone, A; Esposito, G; Piccolo, R
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: ST-Elevation Myocardial Infarction (STEMI); Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.1467
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: A delayed presentation of patients with ST-segment elevation myocardial infarction (STEMI) has been reported globally after the outbreak of coronavirus disease-19 (COVID-19). However, it remains unknown whether differences already exist at the time of pre-hospital electrocardiograms (ECGs). Purpose: We therefore compared pre-hospital ECGs of STEMI patients hospitalized in Italy after the first reported case of COVID-19 on February 21, 2020 with data from the same period in 2019 to identifying potential changes between the two periods. Methods: We analyzed prehospital ECGs of patients with a final diagnosis of STEMI from February 21, 2020, to April 16, 2020. Data were divided in two periods, before and after the first confirmed case of COVID-19 in Italy. Pathological Q-waves and the Anderson-Wilkins acuteness score, which estimates the acuteness of ischemia, were independently assessed by two reviewers. Results: 167 (5.15%) of out 3, 239 ECGs qualified for STEMI and were included in the analysis. ECGs recorded during the COVID-19 pandemic showed more frequently pathological Q-wave complexes compared with the control period (54.5% vs. 22.1%, risk difference 32.3%, 95% confidence intervals [CI], 21.2 to 43.5 percentage points) and presented a higher number of pathological Q-waves (1.4±1.6 vs. 0.5±1.2; p<0.001). The Anderson-Wilkins acuteness score was significantly lower during the COVID-19 period (2.4±0.9 vs. 2.8±0.7; p<0.001), suggesting a lower probability of acute ischemia. Conclusions: Pre-hospital ECGs of patients with a final diagnosis of STEMI presented more frequently the signs of late ischemia during the COVID-19 pandemic. Funding Acknowledgement: Type of funding sources: None.