{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:57:40Z","timestamp":1760057860808,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chang Gung Medical Foundation","award":["CDRPG3L0011"],"award-info":[{"award-number":["CDRPG3L0011"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The coronavirus disease 2019 pandemic presented unprecedented challenges in balancing infection control measures with the timely management of ST-segment elevation myocardial infarction (STEMI), a time-sensitive condition. This study investigates the pandemic\u2019s effects on STEMI management times and outcomes at a high-volume medical center in Taiwan. Materials and Methods: A retrospective analysis of 1309 STEMI patients was conducted at Chang Gung Memorial Hospital between 2017 and 2022. Patients were divided into pre-pandemic and pandemic groups. Measurement outcomes include in-hospital mortality rate, management times (e.g., door-to-balloon time), the rates of intra-aortic balloon pump (IABP) and\/or veno-arterial extracorporeal membrane oxygenation (VA-ECMO) usage, mechanical ventilation, inotropic support, and the length of intensive care unit (ICU) and hospital stay. Kaplan\u2013Meier survival analysis and statistical comparisons were performed to assess temporal trends and prognostic outcomes. Results: No significant difference in in-hospital mortality was observed between pre-pandemic (5.85%) and pandemic (7.03%) groups (p = 0.45). The pandemic group experienced longer management times, including door-to-cath arrival (p = 0.0335) and door-to-balloon time (p = 0.014), although all times remained below the 90 min threshold. Quality improvements during the first outbreak allowed the institution to handle higher case volumes during subsequent waves without further delays. Ninety-day survival analysis showed no significant disparity between groups (p = 0.3655). Conclusions: Pandemic-related delays in STEMI management were effectively mitigated through workflow optimization, preventing significant increases in mortality rates. This study highlights the adaptability of healthcare systems in responding to crises while maintaining quality care for time-sensitive emergencies. Future multicenter studies could provide broader insights into global STEMI management strategies under pandemic conditions.<\/jats:p>","DOI":"10.3390\/medicina61030422","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T06:45:42Z","timestamp":1740725142000},"page":"422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the Coronavirus Disease 2019 Pandemic on the Management and Outcomes of ST-Segment Elevation Myocardial Infarction Patients: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"61","author":[{"given":"Cheng-Han","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Jen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shi-Ying","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3702-7499","authenticated-orcid":false,"given":"Chung-Hsien","family":"Chaou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"},{"name":"Chang Gung Medical Education Research Center, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"key":"ref_1","unstructured":"Taiwan Centers for Disease Control (2025, January 15). Statistics Table of Area, Age, Sex of Death Cases\u2014COVID-19 (by Month of Onset), Available online: https:\/\/data.cdc.gov.tw\/dataset\/death-statistics-cases-19cov?utm_source=chatgpt.com."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2051","DOI":"10.3201\/eid2810.220456","article-title":"Transmission Dynamics and Effectiveness of Control Measures during COVID-19 Surge, Taiwan, April\u2013August 2021","volume":"28","author":"Akhmetzhanov","year":"2022","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1017\/dmp.2020.357","article-title":"Taiwan\u2019s Successful COVID-19 Mitigation and Containment Strategy: Achieving Quasi Population Immunity","volume":"16","author":"Chien","year":"2022","journal-title":"Disaster Med. Public Health Prep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1001\/jamainternmed.2021.1625","article-title":"Lessons From the Success of COVID-19 Control in Taiwan","volume":"181","author":"Steinbrook","year":"2021","journal-title":"JAMA Intern. Med."},{"key":"ref_5","first-page":"1073","article-title":"The impact of COVID-19 on health and health systems","volume":"31","author":"Haileamlak","year":"2021","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2587","DOI":"10.1016\/j.mayocp.2021.07.002","article-title":"Thromboembolic Risk in Hospitalized and Nonhospitalized COVID-19 Patients: A Self-Controlled Case Series Analysis of a Nationwide Cohort","volume":"96","author":"Ho","year":"2021","journal-title":"Mayo Clin. Proc."},{"key":"ref_7","first-page":"228","article-title":"Effect of COVID-19 pandemic on six-month mortality and clinical outcomes of patients with ST-elevation myocardial infarction","volume":"18","author":"Zahid","year":"2022","journal-title":"Adv. Interv. Cardiol. Post\u0119py W Kardiol. Interwencyjnej"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1016\/j.jacc.2020.04.011","article-title":"Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic","volume":"75","author":"Garcia","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1056\/NEJMc2009166","article-title":"Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy","volume":"383","author":"Angelini","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1056\/NEJMc2015630","article-title":"The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction","volume":"383","author":"Solomon","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e536","DOI":"10.1016\/S2468-2667(20)30188-2","article-title":"Hospital admissions for acute myocardial infarction before and after lockdown according to regional prevalence of COVID-19 and patient profile in France: A registry study","volume":"5","author":"Mesnier","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3693","DOI":"10.2169\/internalmedicine.8220-21","article-title":"Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo","volume":"60","author":"Watanabe","year":"2021","journal-title":"Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.mayocpiqo.2020.06.010","article-title":"Status of Acute Myocardial Infarction in Southern India During COVID-19 Lockdown: A Multicentric Study","volume":"4","author":"Meenakshisundaram","year":"2020","journal-title":"Mayo Clin. Proc. Innov. Qual. Outcomes"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.amjcard.2020.06.030","article-title":"No Reduction of ST-segment Elevation Myocardial Infarction Admission in Taiwan During Coronavirus Pandemic","volume":"131","author":"Li","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E010027","DOI":"10.1161\/CIRCINTERVENTIONS.120.010027","article-title":"Patient and Provider Risk in Managing ST-Elevation Myocardial Infarction During the COVID-19 Pandemic: A Decision Analysis","volume":"13","author":"Butala","year":"2020","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"478","DOI":"10.3201\/eid3003.230893","article-title":"Population-Based Evaluation of Vaccine Effectiveness against SARS-CoV-2 Infection, Severe Illness, and Death, Taiwan","volume":"30","author":"Lee","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1161\/01.CIR.0000070420.51787.A8","article-title":"Left ventricular remodeling and ventricular arrhythmias after myocardial infarction","volume":"107","author":"Lee","year":"2003","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1002\/ccd.28946","article-title":"Management of acute myocardial infarction during the COVID-19 pandemic: A Consensus Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP)","volume":"96","author":"Mahmud","year":"2020","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/S0140-6736(14)61932-2","article-title":"Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: A retrospective study","volume":"385","author":"Nallamothu","year":"2015","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1161\/01.CIR.0000121424.76486.20","article-title":"Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: Every minute of delay counts","volume":"109","author":"Suryapranata","year":"2004","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ehj.2004.03.021","article-title":"Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty","volume":"25","author":"Ottervanger","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1001\/jama.2010.1139","article-title":"System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention","volume":"304","author":"Terkelsen","year":"2010","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1093\/eurheartj\/ehaa409","article-title":"Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era","volume":"41","author":"Spaccarotella","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/HPC.0000000000000222","article-title":"COVID-19 Pandemic and Acute Myocardial Infarction: Management Protocol from a British Cardiac Centre","volume":"19","author":"Abdelaziz","year":"2020","journal-title":"Crit. Pathw. Cardiol."},{"key":"ref_25","unstructured":"Chang Gung Medical Hospital Clinical Trial Center (2025, February 13). Chang Gung Medical Hospital Clinical Trial Center\u2014Linkou Branch. Available online: https:\/\/www1.cgmh.org.tw\/intr\/intr2\/c3s400\/profile-linkou.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1996","DOI":"10.1016\/j.amjcard.2018.08.047","article-title":"Patterns of Acute Myocardial Infarction in Taiwan from 2009 to 2015","volume":"122","author":"Lee","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1016\/j.jacc.2024.06.013","article-title":"2024 AHA\/ACC\/ACS\/ASNC\/HRS\/SCA\/SCCT\/SCMR\/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"84","author":"Thompson","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","first-page":"8207","article-title":"Analysis of the Prognosis Outcomes and Treatment Delay Among ST-Segment Elevation Myocardial Infarction Patients in Emergency Department Based on the Presence of Symptoms Suggestive of COVID-19","volume":"13","author":"Kwak","year":"2024","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s12471-021-01653-9","article-title":"COVID-19-mediated patient delay caused increased total ischaemic time in ST-segment elevation myocardial infarction","volume":"30","author":"Sturkenboom","year":"2022","journal-title":"Neth. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.amjcard.2021.12.052","article-title":"Pandemic-Associated Delays in Myocardial Infarction Presentation in Predominantly Rural Counties With Low COVID-19 Prevalence","volume":"169","author":"McNamara","year":"2022","journal-title":"Am. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"326.e1","DOI":"10.1016\/j.ajem.2021.10.023","article-title":"Delayed care in myocardial infarction and ischemic stroke patients during the COVID-19 pandemic","volume":"54","author":"Clodfelder","year":"2022","journal-title":"Am. J. Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e167","DOI":"10.3346\/jkms.2022.37.e167","article-title":"Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction","volume":"37","author":"Choi","year":"2022","journal-title":"J. Korean Med. Sci."},{"key":"ref_33","first-page":"C75","article-title":"Higher mortality in AMI during COVID 19 pandemia: Patient or system delay?","volume":"23","author":"Pappagallo","year":"2021","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1016\/S0735-1097(21)04396-5","article-title":"Presentation delay among patients with ST-segment elevation myocardial infarction outside of a covid-19 hot zone","volume":"77","author":"McNamara","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chen, C.C., Tseng, C.Y., Choi, W.M., Lee, Y.C., Su, T.H., Hsieh, C.Y., Chang, C.M., Weng, S.L., Liu, P.H., and Tai, Y.L. (2020). Taiwan Government-Guided Strategies Contributed to Combating and Controlling COVID-19 Pandemic. Front. Public. Health, 8.","DOI":"10.3389\/fpubh.2020.547423"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1007\/s00392-022-02102-2","article-title":"COVID-19 pandemic affects STEMI numbers and in-hospital mortality: Results of a nationwide analysis in Germany","volume":"112","author":"Oettinger","year":"2022","journal-title":"Clin. Res. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/ehf2.13075","article-title":"Increased mortality and worse cardiac outcome of acute myocardial infarction during the early COVID-19 pandemic","volume":"8","author":"Primessnig","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1136\/heartjnl-2021-319750","article-title":"COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction","volume":"108","author":"Algowhary","year":"2022","journal-title":"Heart"},{"key":"ref_39","first-page":"985","article-title":"Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak","volume":"73","author":"Zamorano","year":"2020","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S15","DOI":"10.5152\/TJAR.2021.21066","article-title":"Cardiovascular Disease, Intensive Care, and Mortality in Coronavirus Disease 2019 Patients: A Meta-Analysis","volume":"50","author":"Sarfraz","year":"2022","journal-title":"Turk. J. Anaesthesiol. Reanim."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1007\/s11427-021-2046-4","article-title":"Twin peaks of in-hospital mortality among patients with STEMI across five phases of COVID-19 outbreak in China: A nation-wide study","volume":"65","author":"Li","year":"2022","journal-title":"Sci. China Life Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"710","DOI":"10.4070\/kcj.2024.0028","article-title":"Trends and Outcomes of Acute Myocardial Infarction During the Early COVID-19 Pandemic in the United States: A National Inpatient Sample Study","volume":"54","author":"Thyagaturu","year":"2024","journal-title":"Korean Circ. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"A13721","DOI":"10.1161\/circ.144.suppl_1.13721","article-title":"Impact of COVID-19 pandemic on door-toballoon time and mortality within a high reliability STEMI system of care","volume":"144","author":"Zheng","year":"2021","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.amjcard.2023.11.035","article-title":"Association of the COVID-19 Pandemic on Treatment Times for ST-Elevation Myocardial Infarction: Observations from the Los Angeles County Regional System","volume":"213","author":"Shavelle","year":"2024","journal-title":"Am. J. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s12928-022-00836-4","article-title":"Comparison of door-to-balloon time and in-hospital outcomes in patients with ST-elevation myocardial infarction between before versus after COVID-19 pandemic","volume":"37","author":"Kobayashi","year":"2022","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1002\/emp2.12325","article-title":"Incidence, delays, and outcomes of STEMI during COVID-19 outbreak: Analysis from the France PCI registry","volume":"1","author":"Range","year":"2020","journal-title":"J. Am. Coll. Emerg. Physicians Open"},{"key":"ref_47","unstructured":"Ministry of Health and Welfare (2024, December 31). Taiwan National Infectious Disease Statistics System, Available online: https:\/\/nidss.cdc.gov.tw\/en\/Home\/Index?op=6."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:44:02Z","timestamp":1760028242000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/3\/422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,27]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["medicina61030422"],"URL":"https:\/\/doi.org\/10.3390\/medicina61030422","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2025,2,27]]}}}