P364 - EVOLVING STEMI DEMOGRAPHICS AND CARE PATTERNS IN A CENTRALIZED CARDIAC SYSTEM DURING THE COVID-19 PANDEMIC: A PROVINCIAL ANALYSIS FROM NEW BRUNSWICK

Background: New Brunswick (NB) combines one of Canada’s oldest populations (nearly one in four over age 65) with a centralized STEMI referral model, uniquely positioning it to reveal how system design influences care resilience under pandemic stress. This aging demographic increases the complexity of cardiovascular disease, intensifying pressure on an already stretched system during the COVID-19 pandemic. The combination of a global pandemic, rural geography, and an aging population presents unique challenges for NB’s centralized acute cardiovascular care system at the New Brunswick Heart Centre (NBHC), the sole tertiary cardiac care facility providing comprehensive ST-Segment Elevation Myocardial Infarction (STEMI) care. This study describes evolving demographics, treatment patterns, and outcomes in NB STEMI patients over the pandemic, with specific attention to how aging influences demand for specialized cardiovascular services and acute care planning.

METHODS AND RESULTS: We reviewed 1697 consecutive STEMI patients presenting to the NBHC between January 2019 and March 2022, stratified into three temporal cohorts: Pre-Pandemic (n=602), Pandemic (n=515), and Late-Pandemic (n=580). These differences failed to reach significance on Poisson regression. The proportion of patients aged >70 years rose significantly (28.4% to 34.8%, p=0.014), along with diabetes prevalence (25.9% to 29.5%, p=0.032). Concurrently, smoking history (46.5% to 38.4%, p=0.004), family history of coronary artery disease (23.9% to 19.3%, p=0.034), and peripheral vascular disease (5.0% to 2.4%, p=0.039) declined. Cardiogenic shock presentations dropped sharply during the pandemic (10.3% to 4.3%, p< 0.001), rebounding to 7.1% thereafter. Cardiac arrest (p=0.097) and intubation at catheterization (p=0.729) remained unchanged. The frequency of emergent “Rescue” PCI increased over time (29.3% to 42.8%, p< 0.001), while primary PCI, staged PCI, thrombolysis, and procedural delays remained largely unchanged (p>0.05), despite pandemic pressures. The proportion of patients requiring surgical revascularization after STEMI dropped notably in the second cohort (11.0% to 6.8%, p=0.045), recovering slightly thereafter. In-hospital mortality (4.7% vs. 2.5% vs. 4.3%, p=0.146) remained consistent.

Conclusion: Despite a progressively older STEMI population, in-hospital outcomes and median system timelines remained stable with minor fluctuations during the COVID-19 pandemic. Our findings suggest that NB’s centralized cardiac care infrastructure adapted reasonably well to the COVID-19 pandemic. These findings reinforce the capacity of streamlined, province-wide referral models to absorb demographic stress without compromising acute care delivery or outcomes. One notable change since the pandemic has been a significant increase in the need for RPCI for reasons that are unclear.