Impact of COVID-19 outbreak on hospital admissions and outcome of acute coronary syndromes in a single high-volume centre in southeastern Europe

Abstract

Background As coronavirus disease 2019 (COVID-19) has reached pandemic status, authors from the most severely affected countries have reported reduced rates of hospital admissions for patients with acute coronary syndrome (ACS). Aim The aim of the present study was to investigate the influence of the COVID-19 outbreak on hospital admissions and outcomes in ACS patients in a single high-volume centre in southeastern Europe. Methods This retrospective observational study aimed to investigate the number of hospital admissions for ACS, clinical findings at admission, length of hospitalisation, major complications and in-hospital mortality during the COVID-19 outbreak and to compare the data with the same parameters during an equivalent time frame in 2019. For the ST-elevated myocardial infarction (STEMI) subgroup of patients, changes in ischaemic times were analysed as well. Results There was a significant reduction of 44.3% in the number of patients admitted for ACS during the COVID-19 outbreak when compared with the same period in 2019 (151 vs 271; 95% confidence interval 38.4–50.2, p < 0.01) with a higher mortality rate (13.2% vs 7.2%, p = 0.03). In 2020, patients with non-ST-elevated myocardial infarction presented more often with acute heart failure (3.3% vs 0.7%, p = 0.04). During the COVID-19 outbreak, we observed increases in the total ischaemic time (303 ± 163.4 vs 200.8 ± 156.8 min, p < 0.05) and door-to-balloon time (69.2 ± 58.4 vs 50.5 ± 31.3 min, p < 0.01) in STEMI patients. Conclusions These findings should increase the awareness of morbidity and mortality related to missed or delayed treatment of ACS among the public and the healthcare services.

Characteristics and Outcomes of Patients with Acute Coronary Syndrome and COVID-19

“…Increased supply-demand mismatch of oxygen in the environment of proinflammatory state and hypoxemia-mediated processes due to acute respiratory distress syndrome may increase the risk of adverse outcomes and be one of the reasons for significantly higher mortality rates in these patients. Late STEMI presentations have been widely reported during the COVID pandemic [ 2 , 18 ]. Deferring urgent medical care and late presentation of STEMI patients have resulted in later treatment, which inevitably worsens outcomes.…”

“…Since the beginning of the Coronavirus disease (COVID-19) pandemic, a significant impact on acute coronary syndrome (ACS) hospitalizations [ 1 ] and mortality rates [ 2 ] has been reported, even in patients without COVID-19. There is a lack of data regarding clinical characteristics and outcomes, with only a few studies on patients with coexistent COVID-19 and ACS.…”

Myocardial revascularization in Russian Federation for acute coronary syndrome in 2016-2020

“…В 2020 году в Российской Федерации, как и во всем мире, в связи с пандемией COVID-19 изменились количественные и качественные показатели результатов оказания медицинской помощи больным с ОКС [8][9][10][11].…”

“…С учетом того, что число госпитализированных пациентов с диагнозом ИМпST в 2020 году было сопоставимо с предыдущими годовыми показателями, впервые в Российской Федерации зарегистрировано серьезное положительное изменение соотношения ИМпST / ОКСбпST=1 / 1,8, которое в предыдущие годы в среднем было на уровне 1 / 2,4. Зарубежные публикации также говорят о сокращении госпитализаций больных с ОКС в большей степени за счет уменьшения больных с ОКСбпST [10,11].…”

“…При этом различий в отдаленной смертности между больными ИМпST и ОКСбпST нет, тем не менее большинство смертельных исходов (до 95 %) при ОКСбпST происходит после выписки из стационара. В 2020 году в мире в связи с пандемией COVID-19 изменились количественные и качественные показатели результатов оказания медицинской помощи больным с ОКС [8][9][10][11].…”