# Impact of the Coronavirus Disease 2019 Pandemic on the Management and Outcomes of ST-Segment Elevation Myocardial Infarction Patients: A Retrospective Cohort Study

## TL;DR

This study examines how the COVID-19 pandemic affected the treatment and outcomes of heart attack patients in Taiwan, finding that delays were managed without increasing mortality.

## Contribution

The study demonstrates that workflow optimization during the pandemic prevented significant mortality increases in STEMI patients.

## Key findings

- No significant difference in in-hospital mortality was observed between pre-pandemic and pandemic groups.
- Pandemic group experienced longer management times but remained below critical thresholds.
- Workflow improvements allowed handling higher case volumes without further delays.

## Abstract

Background and Objectives: The coronavirus disease 2019 pandemic presented unprecedented challenges in balancing infection control measures with the timely management of ST-segment elevation myocardial infarction (STEMI), a time-sensitive condition. This study investigates the pandemic’s effects on STEMI management times and outcomes at a high-volume medical center in Taiwan. Materials and Methods: A retrospective analysis of 1309 STEMI patients was conducted at Chang Gung Memorial Hospital between 2017 and 2022. Patients were divided into pre-pandemic and pandemic groups. Measurement outcomes include in-hospital mortality rate, management times (e.g., door-to-balloon time), the rates of intra-aortic balloon pump (IABP) and/or veno-arterial extracorporeal membrane oxygenation (VA-ECMO) usage, mechanical ventilation, inotropic support, and the length of intensive care unit (ICU) and hospital stay. Kaplan–Meier survival analysis and statistical comparisons were performed to assess temporal trends and prognostic outcomes. Results: No significant difference in in-hospital mortality was observed between pre-pandemic (5.85%) and pandemic (7.03%) groups (p = 0.45). The pandemic group experienced longer management times, including door-to-cath arrival (p = 0.0335) and door-to-balloon time (p = 0.014), although all times remained below the 90 min threshold. Quality improvements during the first outbreak allowed the institution to handle higher case volumes during subsequent waves without further delays. Ninety-day survival analysis showed no significant disparity between groups (p = 0.3655). Conclusions: Pandemic-related delays in STEMI management were effectively mitigated through workflow optimization, preventing significant increases in mortality rates. This study highlights the adaptability of healthcare systems in responding to crises while maintaining quality care for time-sensitive emergencies. Future multicenter studies could provide broader insights into global STEMI management strategies under pandemic conditions.