Objective: To investigate the impact of COVID-19 on treatment of patients with acute ST segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PPCI). Methods: This was a multicenter retrospective study. STEMI patients undergoing PPCI from January 1, 2019 to December 31, 2021 were selected, based on the data of Xinnaolvsetongdao App. Clinical data and treatment time indicators, including symptom to first medical contact (S-FMC), symptom to door (StoD), first medical contact to ECG (FMC-ECG), first medical contact to guide wire (FMC-W), door to balloon (DtoB) and total ischemic time in 2019, 2020 and 2021 were compared. STEMI patients aged<60 years were sub-grouped as the young and middle-aged group, and STEMI patients aged≥60 years were sub-grouped as the elderly group. Results: A total of 7 435 (3 305 in 2019, 1 796 in 2020 and 2 334 in 2021) STEMI patients aged (59.6±12.6) years undergoing PPCI were included in this analysis. There were 5 990 males. For STEMI patients with PPCI in 2019, 2020 and 2021, FMC-ECG was 3 (1, 5) min, 3(1, 7) min and 4 (1, 7) min. FMC-W was 73 (56, 87) min, 78 (62, 95) min and 77 (62, 87) min. DtoB was 73 (56, 85) min, 78 (62, 95) min and 77 (62, 86) min. Total ischemic time was 189 (130, 273) min, 196 (138, 295) min and 209 (143, 276) min. FMC-ECG, FMC-W, DtoB and total ischemic time were longer in 2020 and 2021 than in 2019 (all P<0.05). The proportions of patients with FMC-ECG≤10 min (88.4% (1 588/1 796) vs. 92.7% (3 064/3 305), P<0.05), FMC-W≤120 min (87.9% (1 579/1796) vs. 91.7% (3 030/3 305), P<0.05) and DtoB≤90 min (72.3% (1 298/1 796) vs. 80.8% (2 672/3 305), P<0.05) were lower in 2020 than in 2019, whereas no differences were observed in the proportions of patients with FMC-ECG≤10 min (91.3% (2 131/2 334) vs. 92.7% (3 064/3 305), P=0.054), FMC-W≤120 min (92.0% (2 148/2 334) vs. 91.7% (3 030/3 305), P=0.635) and DtoB≤90 min (80.0% (1 867/2 334) vs. 80.8% (2 672/3 305), P=0.424) in 2021 compared with 2019. In the subgroup analysis, the proportions of patients with FMC-ECG≤10 min, FMC-W≤120 min and DtoB≤90 min were lower in the elderly group than in young and middle-aged group in 2019 (all P<0.05). The proportions of patients with FMC-W≤120 min and DtoB≤90 min were lower in the elderly group than in young and middle-aged group in 2021(all P<0.05). No differences were observed in the proportions of patients with FMC-ECG≤10 min, FMC-W≤120 min and DtoB≤90 min between the two group in 2020 (all P>0.05). Conclusions: Affected by the COVID-19, there is a reduction in the number of PPCI cases and treatment delays in STEMI patients, especially in the elderly. After adjusting the treatment strategy and widely applying the Xinnaolvsetongdao APP, the above indicators are significantly improved in 2021 as compared with 2020.
目的： 研究新型冠状病毒感染对北京市急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PPCI）的影响。 方法： 本研究为多中心回顾性研究。纳入2019年1月1日至2021年12月31日心脑绿色通道APP中所有接受PPCI的STEMI患者。分别收集2019、2020和2021年患者临床资料及STEMI诊疗时间指标［包括发病至首次医疗接触时间（S-FMC）、发病至医院就诊时间（StoD）、首次医疗接触至首份心电图时间（FMC-ECG）、首次医疗接触至导丝通过时间（FMC-W）、进门至球囊扩张时间（DtoB）和总缺血时间］。将年龄<60岁的STEMI患者作为中青年组，年龄≥60岁的STEMI患者作为老年组进行亚组分析。 结果： 最终纳入接受PPCI的STEMI患者7 435例，其中男性5 990例，年龄（59.6±12.6）岁。2019、2020和2021年分别有3 305、1 796和2 334例。2019、2020、2021年接受PPCI的STEMI患者的FMC-ECG分别为3（1，5）min、3（1，7）min、4（1，7）min，FMC-W分别为73（56，87）min、78（62，95）min、77（62，87）min，DtoB分别为73（56，85）min、78（62，95）min、77（62，86）min，总缺血时间分别为189（130，273）min、196（138，295）min、209（143，276）min，2020和2021年就诊患者的FMC-ECG、FMC-W、DtoB和总缺血时间均长于2019年（P均<0.05）。2020年就诊患者中FMC-ECG≤10 min［88.4%（1 588/1 796）比92.7%（3 064/3 305），P<0.05］、FMC-W≤120 min［87.9%（1 579/1 796）比91.7%（3 030/3 305），P<0.05］、DtoB≤90 min者占比［72.3%（1 298/1 796）比80.8%（2 672/3 305），P<0.05］均低于2019年，而2021年与2019年比较FMC-ECG≤10 min［91.3%（2 131/2 334）比92.7%（3 064/3 305），P=0.054］、FMC-W≤120 min［92.0%（2 148/2 334）比91.7%（3 030/3 305），P=0.635］、DtoB≤90 min者占比［80.0%（1 867/2 334）比80.8%（2 672/3 305），P=0.424］差异均无统计学意义。亚组分析结果显示，2019年老年组中FMC-ECG≤10 min、FMC-W≤120 min、DtoB≤90 min者占比均低于中青年组，2021年老年组中FMC-W≤120 min、DtoB≤90 min者占比均低于中青年组（P均<0.05），而2020年两组FMC-ECG≤10 min、FMC-W≤120 min、DtoB≤90 min者比例差异均无统计学意义（P均>0.05）。 结论： 新型冠状病毒感染使北京市接受PPCI的STEMI患者数量减少，急诊救治存在延迟，老年患者为著。经调整急救策略及广泛应用心脑绿色通道APP后，2021年较2020年手术量及救治效率已有明显改善。.