TY - JOUR T1 - COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2020-001432 VL - 7 IS - 2 SP - e001432 AU - Callum D Little AU - Tushar Kotecha AU - Luciano Candilio AU - Richard J Jabbour AU - George B Collins AU - Asrar Ahmed AU - Michelle Connolly AU - Ritesh Kanyal AU - Ozan M Demir AU - Lucy O Lawson AU - Brian Wang AU - Sam Firoozi AU - James C Spratt AU - Divaka Perera AU - Philip MacCarthy AU - Miles Dalby AU - Ajay Jain AU - Simon J Wilson AU - Iqbal Malik AU - Roby Rakhit Y1 - 2020/10/01 UR - http://openheart.bmj.com/content/7/2/e001432.abstract N2 - Objectives To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.Methods We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomesResults There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62–118) min in 2020 vs 75 (57–95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34–65) min in 2020 vs 48 (35–70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3–9) days vs 3 (2–4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.Conclusion These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity. ER -