Figure 1.

Possible Causes for the Delays in Primary PCI in Patients With STEMI During the COVID-19 Pandemic

Multifactorial factors are likely associated with the significant time delays in the diagnosis and treatment of ST-segment elevation myocardial infarction (STEMI), which subsequently results in increases in complications and mortality. Each circle represents a step from symptom onset to primary percutaneous coronary intervention (PCI), and each box represents the possible causes of time delay in each step. First, patients with suspected STEMI may avoid hospital visits owing to the fear of in-hospital exposure to coronavirus disease-2019 (COVID-19), avoidance of medical burden, and a lack of emergency medical service (EMS) workers for patient transfer, through which time delay between initial symptom onset and emergency room (ER) visit occurs. Second, even after arriving at the ER, patients with STEMI may inevitably experience further time delay due to the COVID-19 screening process and the mandatory requirement of the highest-degree personal protective equipment (PPE) and facilities with negative-pressure air conditioning for performing primary PCI in patients with high risks for COVID-19. Cath lab = catheterization laboratory.