The role of STEMI integrated networking system based on tele-cardiology for reducing ischemic time and crossing wire time delayed during COVID 19 pandemic

Abstract

Background : During a public health emergency, such as outbreak of COVID-19, delayed for reperfusion become even more challenging to predict. Telecardiology has the advantage of reducing STEMI patient's access time to the emergency units and reduces the delayed for reperfusion. Purpose: Evaluate the impact of this program on pre-hospital and in-hospital (door-to-balloon) delays in STEMI patients admitted to a Tertiary Healthcare Center in Indonesia who performed Primary PCI between Pre Covid-19 and Covid-19 Era Method : This is a retrospective, observational study that included all patients, 18 to 90 years of age, who presented with STEMI via ACS prehospital network or through the Accident and Emergency department of a General Hospital. They were classified in four groups according to the method of admission: conventional emergency department group pre COVID-19 era (Group A), ACS prehospital network-group pre COVID- 19 era (Group B), Conventional emergency department group in the COVID-19 era (Group C), and ACS prehospital network-group in COVID-19 era (Group D). We selected a time frame of 1 month after declaration of COVID-19 infection as a “Pandemic” (ie, March 1 until December 31th 2020; COVID-19 era group).A group of STEMI patients from a similar time period of last year (ie, March 1 until December 31th 2019; pre-COVID-19 era group) was used as control. Outcomes of interest were number of patients referred for reperfusion, distribution of total ischemic time of patients referred in the network and door to crossing wire time. Results : A total of 184 patients were included in this study (123 Pre-COVID-19 and 61 during the COVID-19 Pandemic) according to the method of admission: Group A, 27 patients, Group B, 96 patients, Group C 25 patients, and Group D 36 patients. We found significant 42% drop in the number of STEMI patients treated by PPCI in this general hospital during pandemic era. Group B had the lowest mean of total ischemic time compare than group A, D, and C (217.34 ± 116 minute, 285 ± 165 minute, 432 ± 204 minute, 609 ± 246 minute, Respectively, P = 0.000. Group B had the lowest mean of crossing wire time compare than group A, D, and C (82 ± 10.9 minute, 96.4 ± 48 minute, 175 ± 41 minute, 132 ± 38 minute, Respectively, P = 0.000. The proportion of ischemic time delay > 720 minutes was more higher in Group C than Group D (36% vs 13.9%, P = 0.045, respectively). The proportion of crossing wire time > 140 minutes was more higher in Group C than group D (76% vs 27.8%, respectively, P = 0.000). The proportion of inhospital mortality was more higher in group C compare than group D ( 32% vs 11.1%, respectively, P = 0.045). Conclusion : Our STEMI networking based on tele-cardiology system reduce the ischemic time delayed, Crossing wire time delayed and Inhospital mortality during pandemic COVID-19 era. (Figure Presented).