Crit Pathw Cardiol. 2026 Feb 3. doi: 10.1097/HPC.0000000000000419. Online ahead of print.
ABSTRACT
BACKGROUND: During the COVID-19 pandemic, a temporary policy change required Emergency Medical Services (EMS)-identified ST-elevation myocardial infarction (STEMI) patients to undergo COVID testing in the emergency department (ED) prior to percutaneous coronary intervention (PCI), suspending the standard ED bypass to the catheterization lab. We compared system performance metrics during this COVID-era routing to pre- and post-pandemic periods in a large rural health system.
METHODS: This was a retrospective single-center cohort study of consecutive EMS-identified STEMI activations across three periods: pre-COVID (5/27/2018-3/26/2020), COVID-era ED routing (3/27/2020-1/25/2022), and post-COVID with resumed ED bypass (1/26/2022-11/26/2023). Primary outcomes were standard STEMI system performance metrics; the secondary outcome was in-hospital mortality.
RESULTS: A total of 373 patients were included (pre-COVID: 132; COVID: 104; post-COVID: 137). Compared to pre-COVID, the median time from EMS first medical contact to device time increased by 13 minutes (p = 0.017). The median time from symptom onset to device time increased by 30 minutes (p = 0.0013). The median time of first EMS ECG to device placement was increased by 14 minutes (p=0.013). The median door to device time was increased by 6 minutes (p = 0.0007). There was a non-significant trend toward higher in-hospital mortality during the COVID era.
CONCLUSION: In a rural STEMI system, pandemic-era routing of EMS-identified patients through the ED was associated with significant delays in key reperfusion metrics. While in-hospital mortality did not differ significantly, likely due to limited statistical power, these findings underscore the importance of preserving streamlined STEMI pathways. Larger multicenter studies to assess outcomes are warranted.
PMID:41641615 | DOI:10.1097/HPC.0000000000000419
