1. Comparison of clinical data in all patients with AMI
Compared with Before COVID-19 group, the age, male, current smoking, hypertension, diabetes, stroke, Countryside, STEMI and BMI were not statistically significant in During COVID-19 group. This finding ensures the comparability of the data. In AMI Total, compared with Before COVID-19 group, the hospital stay was prolonged and the proportion of revascularization was decreased in During COVID-19 group, but them were not statistically significant, while the proportion of killip class≥2 was significantly higher. In Urban AMI, the hospital stay, the proportion of killip class≥2 and revascularization had no significant difference between Before COVID-19 group and During COVID-19 group. In Rural AMI, hospital stay and the proportion of killip class≥2 were increased in During COVID-19 group (Table 1).
2. Treatment time of STEMI patients
The S to D Total in STEMI Total (299.0 [158.00–600.00] vs. 659.5 [242.50–1020.00] min, P < 0.001), Urban STEMI (179.0 [119.00–419.00] vs. 660.0 [180.00–960.00] min, P = 0.003) and Rural STEMI (360.0 [197.00–720.00] vs. 659.0 [298.00–1080.00] min, P = 0.001) were significantly prolonged in During COVID-19 group compared with Before COVID-19 group. Next, the data of patients undergoing emergency PCI were extracted and compared. The S to D, D to B and S to B in STEMI Total (189.5 [119.00–345.00] vs. 250.0 [180.00–420.00] min, P = 0.008; 75.0 [62.25–87.00] vs. 97.0 [82.00–120.00] min, P < 0.001; 266.5 [188.50–411.75] vs. 367.0 [281.00–522.00] min, P = 0.002) and Rural STEMI (239.0 [174.50–366.50] vs. 300.0 [240.00–450.00] min, P = 0.04; 75.0 [61.00–92.50] vs. 99.0 [84.50–118.00] min, P < 0.001; 328.0 [244.00–432.5] vs. 405.0 [334.00–537.50] min, P = 0.017) were longer in During COVID-19 group than those in Before COVID-19 group. In Urban STEMI, only D to B (81.0 [64.00–85.00] vs. 94.0 [80.75–127.00] min, P = 0.003) was extended in During COVID-19 group compared with Before COVID-19 group, although S to D (125.0 [88.00–266.00] vs. 180.0 [138.75–52.50] min, P = 0.120) and S to B (240.0 [169.00–331.00] vs. 272.5 [244.00–472.75] min, P = 0.056) become longer, they were not statistically significant (Figure 1).
3. The proportion of Invasive treatment time within 24 hours in NSTEMI patients
Compared with Before COVID-19 group, the proportion of Invasive treatment time within 24 hours in NSTEMI Total (70.9% vs. 30.8%, P < 0.001), Urban NSTEMI (73.7% vs. 34.5%, P = 0.001) and Rural NSTEMI (68.8% vs. 26.1%, P = 0.001) were obviously lowered in During COVID-19 group (Table 2).
Table 2
Invasive treatment time in NSTEMI patients
|
NSTEMI Total
|
Urban NSTEMI
|
Rural NSTEMI
|
Before
COVID-19 (n = 86)
|
During
COVID-19
(n = 52)
|
P
|
Before
COVID-19 (n = 38)
|
During
COVID-19
(n = 29)
|
P
|
Before
COVID-19 (n = 48)
|
During
COVID-19
(n = 23)
|
P
|
Invasive treatment time<24h,n (%)
|
61(70.9%)
|
16(30.8%)
|
<0.001
|
28(73.7%)
|
10(34.5%)
|
0.001
|
33(68.8%)
|
6(26.1%)
|
0.001
|
NSTEMI Non-ST-segment elevation myocardial infarction |
4. Comparison of the prognosis in all patients
In AMI Total, MACE (17.3% vs. 29.7%, P = 0.008) and all-cause mortality (5.6% vs. 12.5%, P = 0.027) were increased in During COVID-19 group compared with Before COVID-19 group, and similar results were observed in Rural AMI (19% vs. 31.9%, P = 0.043; 5.2% vs. 13.9%, P = 0.037). Compared with Before COVID-19 group, there was no significant difference in MACE and all-cause mortality in During COVID-19 group in Urban AMI (Table 3).
Table 3
Comparison of the prognosis in all patients
|
AMI Total
|
Urban AMI
|
Rural AMI
|
Before
COVID-19 (n = 197)
|
During
COVID-19
(n = 128)
|
P
|
Before
COVID-19 (n = 81)
|
During
COVID-19
(n = 56)
|
P
|
Before
COVID-19 (n = 116)
|
During
COVID-19
(n = 72)
|
P
|
MACE, n (%)
|
34(17.3%)
|
38(29.7%)
|
0.008
|
12(14.8%)
|
15(26.8%)
|
0.083
|
22(19%)
|
23(31.9%)
|
0.043
|
All-cause mortality, n (%)
|
11(5.6%)
|
16(12.5%)
|
0.027
|
5(6.2%)
|
6(10.7%)
|
0.521
|
6(5.2%)
|
10(13.9%)
|
0.037
|
Reinfarction, n (%)
|
7(3.6%)
|
7(5.5%)
|
0.406
|
2(2.5%)
|
3(5.4%)
|
0.672
|
5(4.3%)
|
4(5.6%)
|
0.909
|
NCHF, n (%)
|
16(8.1%)
|
15(11.7%)
|
0.281
|
5(6.2%)
|
6(10.7%)
|
0.521
|
11(9.5%)
|
9(12.5%)
|
0.514
|
AMI Acute myocardial infarction; NCHF New congestive heart failure |
5. MACE of the AMI Patients During and Before COVID-19
Through Kaplan-Meier analysis, it was found that the occurrences of MACE in AMI Total and Rural AMI were significantly higher in During COVID-19 group compared with Before COVID-19 group, there was no significant difference in Urban AMI (Figure 2).
6. Mortality of the AMI Patients During and Before COVID-19
Through Kaplan-Meier analysis, it was found that the survival in AMI Total and Rural AMI was significantly reduced in During COVID-19 group compared with Before COVID-19 group, there was no significant difference in Urban AMI (Figure 3).