Impact of the COVID-19 pandemic on emergency department utilization of initial fibrinolysis for the treatment of STEMI

Objective

Fibrinolysis is generally considered an alternative to percutaneous coronary intervention (PCI) for ST-Segment Elevation Myocardial Infarction (STEMI) when PCI is not immediately feasible. The COVID-19 pandemic may have impacted the timeliness of PCI. We sought to compare the rate of fibrinolysis use before vs. during the COVID-19 pandemic in US emergency departments (EDs). Characteristics of patients and EDs with fibrinolysis use prior to vs. during the COVID-19 pandemic were also compared.

Methods

We identified adult patients presenting to US EDs for STEMI using the Nationwide Emergency Department Sample (NEDS) database. The cohort was restricted to individuals receiving fibrinolysis. Patients were divided into two cohorts based on receipt of fibrinolysis during the pre-pandemic (April 2018–December 2019) and pandemic (April 2020–December 2021) time periods.

Results

In the period prior to the COVID-19 pandemic, fibrinolysis use was identified in 1593 ED encounters, representing a rate of 24.5 per 1000 STEMI encounters in the database. In the COVID-19 pandemic period, fibrinolysis use was identified in 1700 encounters, representing a rate of 28.2 per 1000 STEMI encounters in the database. This corresponded to a rate difference of 3.7 per 1000 STEMI encounters (95 % confidence interval: 1.9–5.5, p < 0.001). Most ED and patient characteristics were similar prior to vs during the pandemic among included cohorts.

Conclusions

Fibrinolytic therapy use increased, but only slightly, during the COVID-19 pandemic. This suggests that the healthcare system adapted quickly to changes during the pandemic in the setting of STEMI treatment.