Syed Waqar Ahmed1, Nasir Rahman1, Osman Faheem1, Ghufran Adnan1, Ihsanullah Dawlat1, Sheema Saadia1, Maha Inam1, Maria Khan1

1Aga Khan University Hospital, Karachi, Pakistan

Background:
The COVID-19 outbreak has led to hospitals modifying the established systems of care and governments placing their countries under complete or partial lockdown. Consequently, studies from the developed world have reported the negative impact of the pandemic on the presentation and management of STEMI patients.  Hence the aim of this study was to investigate the impact of COVID-19 outbreak on the presentation and management of STEMI patients in a low-middle income country (LMIC)

Method(s):
A single-centre observational study conducted at AKUH, Karachi, Pakistan.  Data was collected for patients and consequently grouped as STEMI patients presenting at the centre from 25th March 2020 to 25th June 2020 (COVID period) and STEMI patients admitted during the equivalent months in 2019 (pre-COVID period). STEMI was defined according to the Fourth Universal Definition of Myocardial Infarction and Ischemia time as the time from onset of symptoms to first medical contact.

Result(s):
Significantly less number of STEMI patients were admitted during the COVID period (n=23) compared to the pre COVID period (n=47).  During the COVID period, STEMI patients had a delayed presentation to the hospital as indicated by the increased ischemia time of 203+-20 min vs. 111+-14 min in the pre-COVID period (p <0.001). Moreover, the intra-hospital door to balloon time was also significantly increased during the COVID period (122+-20 vs 76+-20 min, p<0.001). Consequently, only 17% of the patients presenting in the COVID period achieved the target door to balloon time of 90 minutes.

Conclusion(s):
This is an important report from an LMIC confirming the negative impact of the pandemic on STEMI presentations. These findings point out the need for LMIC in preparing an integrated health care system that can withstand the effects of future pandemics and disasters while having a minimal impact on the presentation and management of cardiovascular patients.