What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute Coronary Syndrome (n=4408). Intervention: Post-COVID-19 pandemic period vs. Pre-COVID-19 pandemic period. Primary outcome: 6-month Major Adverse Cardiovascular Events (MACE) (p=0.131).

What does this research mean for the field?

Previous SARS-CoV-2 infection and COVID-19 vaccination status are not significantly correlated with the incidence, clinical outcomes, or medium- to long-term major adverse cardiovascular events in patients presenting with acute coronary syndrome. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study compares acute coronary syndrome characteristics and outcomes in patients before and after the COVID-19 pandemic.

June 3, 2026Open Access

Trends in Acute Coronary Syndrome Before and After the COVID-19 Pandemic: the Role of Infection or Vaccination

Resultado clave

Hospitalization for acute coronary syndrome in the post-COVID-19 pandemic period was not associated with a significant difference in 6-month major adverse cardiovascular events compared to the pre-pandemic period.

Puntos clave

This study compares acute coronary syndrome characteristics and outcomes in patients before and after the COVID-19 pandemic.
Retrospective, single-center study of patients hospitalized with ACS from 2018 to 2024.
Subgroup analyses based on COVID-19 infection and vaccination status in the post-pandemic cohort.
Comparison of clinical characteristics like age, sex, ACS subtype, and outcomes including major adverse cardiovascular events.
Increased STEMI hospitalizations and decreased NSTEMI cases observed post-pandemic.
Length of hospital stay for coronary artery disease was significantly longer after the pandemic.
No significant differences in mortality rates or MACE rates between pre- and post-pandemic periods.

Diseño del estudio

Tipo

Cross-Sectional (n=4,408)

Multicéntrico

PICO estructurado

Does the COVID-19 pandemic, prior infection, or vaccination status affect the incidence, clinical characteristics, and outcomes of patients hospitalized with acute coronary syndrome?

Población

4,408 adults aged 18 and older hospitalized with acute coronary syndrome were evaluated to compare clinical characteristics and outcomes between the pre-pandemic and post-pandemic periods.

Exposición

Post-pandemic period (2023-2024) and COVID-19 infection/vaccination status

Comparador

Pre-pandemic period (2018-2019) and no COVID-19 infection/vaccination

Resultado

Clinical characteristics, ACS subtype, major adverse cardiovascular events (MACE), length of hospital stay, and mortalityhard clinical

COVID-19 vaccination and prior infection were not associated with adverse clinical outcomes or increased MACE rates in patients presenting with ACS.

Resultado numérico

Tasa de eventos absoluta: 2.9% vs 3.7%

valor p: p=0.131

Limitaciones

Single-center design limits generalizability to the broader population
Potential misclassification of asymptomatic or undocumented COVID-19 infections
Lack of data regarding the timing of COVID-19 infection or vaccination and the severity of prior infection
Insufficient statistical power for detailed subgroup analyses by vaccine type
Possibility of residual confounding despite adjustment for major confounders
Systemic changes during the pandemic, including alterations in diagnostic and treatment pathways, may have influenced the results

Resumen

Abstract Aim This study aimed to compare the clinical characteristics and outcomes of patients hospitalized with acute coronary syndrome (ACS) before and after the COVID-19 pandemic, with particular emphasis on COVID-19 infection history and vaccination status. Materials and methods This retrospective, single-center study included patients admitted to the emergency department (ED) and hospitalized with a diagnosis of ACS during the pre-pandemic period (2018–2019) and the post-pandemic period (2023–2024). Patients were compared in terms of age, sex, ACS subtype, comorbidities, major adverse cardiovascular events (MACE), length of hospital stay, and mortality. In the post-pandemic cohort, subgroup analyses were performed based on COVID-19 infection status and vaccination status. Results A total of 4,408 patients were included, of whom 1,164 (26.4%) were female and 3,244 (73.6%) were male, with a mean age of 59.1 ± 12.5 years. No significant differences were observed between the pre- and post-pandemic periods regarding age, sex distribution, total ACS case numbers, or MACE rates. However, a statistically significant increase in STEMI-related hospitalizations and a significant decrease in the proportion of NSTEMI cases were observed in the post-pandemic period. The length of hospital stay for coronary artery disease was significantly longer after the pandemic, whereas mortality rates did not differ significantly between periods. Conclusion Our findings reveal no significant correlation between COVID-19 vaccination or previous SARS-CoV-2 infection and the incidence of ACS presentations. Additionally, we observed no notable influence on clinical outcomes or medium- to long-term MACE rates among patients hospitalized with ACS in the post-pandemic period. While these findings suggest no adverse association between vaccination status and clinical outcomes among patients presenting with ACS, further large-scale, multicenter studies are needed to clarify potential long-term associations.

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