Article Text

Original research
Effect of the COVID-19 pandemic on mortality of patients with STEMI: a systematic review and meta-analysis
  1. Manuel Rattka1,
  2. Jens Dreyhaupt2,
  3. Claudia Winsauer1,
  4. Lina Stuhler1,
  5. Michael Baumhardt1,
  6. Kevin Thiessen1,
  7. Wolfgang Rottbauer1,
  8. Armin Imhof1
  1. 1Department of Cardiology, Ulm University Medical Center, Ulm, Germany
  2. 2Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  1. Correspondence to Professor Armin Imhof, Department of Cardiology, Ulm University Medical Center, Ulm D-89081, Germany; armin.imhof{at}


Aims Since the beginning of the SARS-CoV-2 outbreak, hospitals reported declining numbers of patients admitted with ST-segment elevation myocardial infarction (STEMI), indicating that the pandemic might keep patients from seeking urgent medical treatment. However, data on outcomes and mortality rates are inconsistent between studies.

Methods A literature search and meta-analysis were performed on studies reporting the mortality of patients with STEMI admitted before and during the COVID-19 pandemic using PubMed, Embase and Web of Science. Additionally, prehospital and intrahospital delay times were evaluated.

Results Outcomes of a total of 50 123 patients from 10 studies were assessed. Our study revealed that, despite a significant reduction in overall admission rates of patients with STEMI during the COVID-19 pandemic (incidence rate ratio=0.789, 95% CI 0.730 to 0.852, I2=77%, p<0.01), there was no significant difference in hospital mortality (OR=1.178, 95% CI 0.926 to 1.498, I2=57%, p=0.01) compared with patients with STEMI admitted before the outbreak. Time from the onset of symptoms to first medical contact was similar (mean difference (MD)=33.4 min, 95% CI −10.2 to 77.1, I2=88%, p<0.01) while door-to-balloon time was significantly prolonged in those presenting during the pandemic (MD=7.3 min, 95% CI 3.0 to 11.7, I2=95%, p<0.01).

Conclusion The significant reduction in admission of patients with STEMI was not associated with a significant increase of hospital mortality rates. The causes for reduced incidence rates remain speculative. However, the analysed data indicate that acute and timely medical care of these patients has been maintained during the pandemic in most countries. Long-term data on mortality have yet to be determined.

  • acute coronary syndrome
  • epidemiology
  • meta-analysis
  • systematic reviews as topic

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  • Contributors MR and AI had the idea for and designed the study and had full access to all the data. MR and MB collected the data. JD performed the statistical analysis. MR, CW and LS mainly wrote the manuscript with support from AI and KT. AI and WR were mainly responsible for interpretation of the data and supervised the project. All authors provided critical feedback and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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