a case of pneumonia of unknown cause was reported in Wuhan, China (1). The infection caused by a newly identified coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread all over the world, causing the current pandemic of coronavirus 2019 disease (COVID-19) (2).The Albanian government, progressively since March 09, 2020, (3) (the first case declared) urged and ordered physical distancing and strict movement restriction measures. Total containment measures; closure of all activities and restriction of movement except for healthcare workers and other vital services, began on March 16, 2020 (4). At the end of April 2020, Albania had a low COVID-19 incidence rate of 27/100,000 and a low mortality rate of 1.08/100,000 inhabitants (5). The COVID-19 outbreak did not affect the structure and organization of hospital cardiac services in Albania. Patients suffering from COVID-19 have been treated in specialized hospital facilities.The SARS-CoV-2 infection is associated with an increase in thrombotic complications and an inflammatory impact on atherosclerotic plaque progression (6, 7).

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%; weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0; p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%; weekly MID 7.3 [0.6-15.2]; p = 0.048]; NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4]; p < 0.001]. Invasive procedures were also reduced: coronary angiography by 42.5%, weekly MID 26.6 [13.4-39.2]; p = 0.001]; percutaneous coronary intervention (PCI) by 42.3%, weekly MID 16.1 [5.9-26.3], p = 0.004]. Compared to 2019, during the COVID-19 period, there was a 2.4 fold increase in the inhospital death (3% vs 7.2%) with a significant weekly MID 1.4 [0.2-2.7) P=0.032]. A 2.6-fold increase in the occurrence of cardiogenic shock was also observed (13.1% vs. 5.1%, p < 0.0001). CONCLUSIONS: The admissions for ACS and invasive revascularization procedures were significantly reduced, whereas the death rate was increased during COVID 19 pandemic outbreak in Albania compared with the same period in 2019.

Background The incidence of acute coronary syndromes (ACS) decreased during the coronavirus disease 2019 (COVID-19) pandemic. Few studies have investigated gender differences in ACS admissions and outcomes during pandemics and have presented divergent results. This study aimed to investigate the effect of the COVID-19 pandemic on male and female hospitalizations and in-hospital outcomes in patients presenting with ACS. Methodology We designed a retrograde, single-center trial gathering data for ACS hospitalizations during the lockdown (March 9, 2020, to April 30, 2020) compared with the same timeframe of 2019. ACS hospitalizations were subgrouped as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). We calculated the incidence rate ratio (IRR) to compare all-ACS and subgroups for male and female hospitalizations and the risk ratio (RR) to compare overall male/female mortality. Results This study included 321 ACS patients (238 males, 83 females) during the COVID-19 lockdown and 550 patients (400 males, 150 females) during 2019. The IRRs of all-ACS/males/females were significantly lower during the COVID-19 period at 0.58 (95% confidence interval (CI) = 0.44-0.76), 0.59 (95% CI = 0.43-0.75), and 0.55 (95% CI = 0.37-0.74), respectively. The IRR for STEMI was significantly lower among females (0.59 (95% CI = 0.39-0.89)), but not among males (0.76 (95% CI = 0.55-1.08)) The IRR for NSTEMI was not significantly lower, meanwhile it was significantly lower for UA among both males and females. The overall ACS mortality increased during the COVID-19 period (7.4% vs. 3.4%; RR = 2.16 (95% CI = 1.20-3.89)). Important increase was found in males (7.45% vs. 2.5%; RR = 3.02 (95% CI = 1.42-6.44)), but not in females (7.2% vs. 6%; RR = 1.20 (95% CI = 0.44-3.27). Conclusions The admissions of ACS reduced similarly in males and females during the COVID-19 pandemic. The admissions of STEMI reduced predominantly in females. We identified a substantial increase in the overall ACS mortality, but predominantly in males, reducing the differences between males and females. Further studies are necessary to better understand the increase in male mortality during the pandemic.

BackgroundMultiple studies conducted worldwide and in Albania documented an important reduction of acute STelevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period. MethodsA retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30 th , the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period. ResultsThe study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions ]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)]. ConclusionsAfter the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.

Background Cardiovascular diseases remain the number one cause of mortality in the world despite modern scientific and therapeutic advancement. Gender difference pathophysiology, treatment and outcome have been hypothesized and studied. Whether there are sex differences in the outcome after PCI remains controversial. Aim of the study We undertook this study to assess whether there are sex-related differences in intrahospital outcome of patients undergoing percutaneous coronary intervention. Materials and methods This is a prospective observational study. We enrolled consecutively all patients undergoing PCI in UHC “Mother Theresa” from April to October 2018 and were followed in the 1st Clinic of Cardiology. Data for 352 patients were collected, 261 males and 91 females. We excluded from the study patients that could not be followed. Results Women were older (5.27; 95% CI: 2.98–7.6; p<0.001), had more hypertension (p≤0.001), Diabetes Mellitus (p≤0.001), while men were more likely to be smokers (p≤0.001). Female sex had a higher unadjusted mortality rate (5.5% vs. 1.5%, p=0.039) which vanished after adjustments for age, co-morbidities and procedural or infarct related complications (p=0.237). The age-group with the highest mortality rate was that of 61–70 years. Women had more procedure related complications like inguinal hematomas (p=0.02), pseudo aneurisms (p=0.005) and contrast induced nephropathy (p=0.021). Female gender was associated with more severe peri-procedural arrhythmias in the setting of AMI (p=0.039). Total hospital stay was longer for women (p=0.001), after elective PCI (p=0.01) and after primary PCI (p=0.007). After multivariate analysis and adjustment, female gender remained an independent factor for prolonged hospitalization. Conclusion Female sex seems to have a tendency for higher mortality even after losing its significance after multivariate adjustments. Females get more myocardial infarction and procedural related complications and have longer hospital stays than men.