• Tarek A Hammad, Melanie Parikh, Nour Tashtish, Cynthia M Lowry, Diane Gorbey, Farshad Forouzandeh, Steven J Filby, William M Wolf, Marco A Costa, Daniel I Simon, and Mehdi H Shishehbor.
• Cardiovascular Interventional Center, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
• Catheter Cardiovasc Interv. 2021 Feb 1; 97 (2): 208-214.

ObjectivesWe sought to study the impact of COVID-19 pandemic on the presentation delay, severity, patterns of care, and reasons for delay among patients with ST-elevation myocardial infarction (STEMI) in a non-hot-spot region.BackgroundCOVID-19 pandemic has significantly reduced the activations for STEMI in epicenters like Spain.MethodsFrom January 1, 2020, to April 15, 2020, 143 STEMIs were identified across our integrated 18-hospital system. Pre- and post-COVID-19 cohorts were based on March 23rd, 2020, whenstay-at-home orders were initiated in Ohio. We used presenting heart rate, blood pressure, troponin, new Q-wave, and left ventricle ejection fraction (LVEF) to assess severity. Duration of intensive care unit stay, total length of stay, door-to-balloon (D2B) time, and radial versus femoral access were used to assess patterns of care.ResultsPost-COVID-19 presentation was associated with a lower admission LVEF (45 vs. 50%, p = .015), new Q-wave, and higher initial troponin; however, these did not reach statistical significance. Among post-COVID-19 patients, those with >12-hr delay in presentation 31(%) had a longer average D2B time (88 vs. 53 min, p = .033) and higher peak troponin (58 vs. 8.5 ng/ml, p = .03). Of these, 27% avoided the hospital due to fear of COVID-19, 18% believed symptoms were COVID-19 related, and 9% did not want to burden the hospital during the pandemic.ConclusionsCOVID-19 has remarkably affected STEMI presentation and care. Patients' fear and confusion about symptoms are integral parts of this emerging public health crisis.© 2020 Wiley Periodicals LLC.

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