Worrisome trends of ST-elevation myocardial infarction during the Covid-19 pandemic: Data from Portuguese centers

Oliveira, L; Teles, Rui Campante; Machado, C; Madeira, Sérgio; Vale, Nélson; Almeida, Carla; Brito, João; Leal, Sílvio; Raposo, Luís; Gonçalves, Pedro de Araújo; Pacheco, A; Gabriel, Henrique Mesquita; Almeida, Manuel; Martins, Dinis; Mendes, Miguel

doi:10.1016/j.repc.2021.03.012

Cited by 5 publications

(10 citation statements)

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“…The demographic characteristics of patients were similar and coronary artery disease had the same severity between the two periods, which is in agreement with previous reports from various Portuguese regions. 24,27 Nonetheless, without mortality data from the non-SARS-CoV-2 patients, we still do not know if there was a real reduction in ACS incidence or just a reduction of ACS admissions secondary to decreased demand for medical assistance.…”

Section: Discussionmentioning

confidence: 99%

“…23 Many Portuguese centers described the impact of the pandemic on their healthcare assistance, namely its impact on STEMI patients. 24,25 Moreover, different authors reported a more substantial reduction in the incidence of NSTEMI over STEMI. 10,26 Our data reported an overall reduction of ACS events , with an absolute decrease of all types of ACS at a national level, although the proportions of the ACS subtypes remained the same.…”

Section: Discussionmentioning

confidence: 99%

“…28 This was not the case in Portugal since no differences in reperfusion strategies were found in the national database or other national series. 24,25,27 Also, no differences were reported concerning the clinical presentation and management of the ACS between the two periods.…”

Section: Discussionmentioning

confidence: 99%

“…Our results demonstrated the absence of delays regarding all times to medical assistance and reperfusion in the pandemic context, which is in line with several series of Portuguese healthcare institutions, although a trend towards a delay during the pandemic was observed. 24,25,27 Other countries reported different outcomes, given some countries were able to maintain the times from the onset of symptoms until reperfusion 29,30 while others presented a delay. 22 Therefore, in Portugal, the overall provision of medical assistance and reperfusion did not seem to have been influenced by the SARS-CoV-2 pandemic, probably because the Portuguese healthcare system did not collapse 31 during the first wave of the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Even so, some authors from Portuguese healthcare institutions presented different results, with a higher incidence of mechanical ACS complications and in-hospital mortality. 24 Nonetheless, if we consider the reduction in the number of documented ACS events nationwide, it's possible that the prognosis of the patients properly identified as ACS during the pandemic is the same as the patients in the previous years. If we consider that the reduction of ACS events may be due to patients avoiding healthcare systems, the overall prognosis of ACS may be worse than perceived, given that eventually patients without proper assistance during the acute event may develop heart failure and other late complications.…”

Section: Discussionmentioning

confidence: 99%

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The National Response to Patients with Acute Coronary Syndrome during the First Wave of the COVID-19 Pandemic in Portugal

Santos

Santos²,

Paula³

et al. 2022

Acta Med Port

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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to changes in healthcare institutions and medical assistance. Non-SARS-CoV-2 related diseases were indirectly affected by the pandemic. Nonetheless, their treatment remains crucial. Cardiovascular conditions such as acute coronary syndrome (ACS) are common, and it was necessary to adjust medical assistance to these diseases during the pandemic. This study aimed to assess the national impact and healthcare system response during the first wave of the pandemic in patients admitted for ACS.Material and Methods: Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry between the 1st January 2016 and the 28th February 2021. Two groups were defined: the previous year to the SARS-CoV-2 pandemic (March, April, May and June 2019) (952 patients) and the first wave of the pandemic (March, April, May and June 2020) (642 patients). Clinical course, time until reperfusion, in-hospital outcomes and follow-up at one year were compared between both periods.Results: There was a lower incidence of ACS between March and June 2020 compared with the same period in 2019, with a reduction of 32.6%. There were no statistically significant differences between the two periods regarding patient demographic characteristics (except for a higher prevalence of familiar cardi vascular history and chronic obstructive pulmonary disease in 2020 and higher prevalence of diabetes in 2019), clinical features, clinical management, in-hospital major adverse cardiac events, mortality and readmission at one-year follow-up. There was a trend towards longer delays until reperfusion, yet without statistical significance. The patients that developed ACS during the first wave of the SARS-CoV-2 pandemic were less often referred to percutaneous coronary intervention centers (p = 0.034) and were more frequently transferred to another hospital (p < 0.001).Conclusion: During the first wave of the SARS-CoV-2 pandemic there was a nationwide reduction in demand of healthcare services due to ACS events. Even though the Portuguese healthcare system was under strain and forced to divert resources and medical assistance towards the pandemic management, it was capable of responding adequately to ACS.

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Section: Discussionmentioning

confidence: 99%