What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome (n=5421). Intervention: Admission during post-lockdown period (June-October 2020) vs. Admission during corresponding timeframe in 2019. Primary outcome: In-hospital mortality (HR 1.96, 95% CI 1.04-3.70, p=0.04).

January 31, 2023Open Access

Incidence and course of acute coronary syndrome cases after the first wave of the COVID-19 pandemic

Key Result

Suffering from acute coronary syndrome in the period following the first COVID-19 lockdown was associated with a significantly increased risk of in-hospital mortality compared to the same period in 2019 (HR 1.96).

Study Design

Type

Observational (n=5,421)

Multicenter

Yes

Structured PICO

Does hospitalization for ACS during the post-first-wave COVID-19 pandemic period increase mortality risk compared to the pre-pandemic period?

Population

5,421 patients hospitalized for acute coronary syndrome (ACS) across 10 interventional cardiology departments in Poland (2,801 in 2019 and 2,620 in 2020).

Intervention

Hospitalization for ACS during the post-first-wave COVID-19 period (June-October 2020)

Comparator

Hospitalization for ACS during the corresponding pre-pandemic timeframe (June-October 2019)

Outcome

Incidence, patient profile, course of treatment, and clinical outcomes including mortality and major adverse cardiac and cerebrovascular events (MACCE)hard clinical

The post-first-wave COVID-19 period was associated with a higher comorbidity burden and increased mortality risk among patients presenting with acute coronary syndrome.

Main Result

Effect estimate: HR 1.96 (95% CI 1.04-3.70)

Absolute Event Rate: 2.7% vs 1.9%

p-value: p=0.04

Limitations

Retrospective dataset analysis
Difficult to assess true long-term survival and complication incidence due to higher occurrence of comorbidities

Abstract

BACKGROUND: The collateral damage caused by the COVID-19 pandemic affected cardiovascular disease patients, mainly acute coronary syndrome (ACS) cases. Additionally, lockdown caused treatment-related concerns and reluctance to seek medical help, factors that can delay treatment. AIM: We aimed to analyze the incidence and course of ACS after the first COVID-19 wave. METHODS: The report is based on a multi-institutional registry of 10 interventional cardiology departments. ACS patient data were gathered from June to October 2020, i.e. in the period following the first lockdown in Poland (March 30-May 31, 2020) and compared with the corresponding 2019 timeframe. RESULTS: Patients (2801 and 2620) hospitalized for ACS in 2019 and 2020 (June-October) represented 52.8% and 57.9% of coronary artery disease admissions, respectively. In 2020 vs. 2019, more cases of arterial hypertension (80.2% vs. 71.5%; P <0.001), diabetes (32.7% vs. 28.2%; P <0.001) hyperlipidemia (53.2% vs. 49.8%; P = 0.01), and smoking history (29.5% vs. 25.8%; P = 0.003) were detected. Median troponin and cholesterol values, as well as glycemia, were higher in 2020. Patients were more likely to undergo percutaneous treatment (91.2% vs. 87.5%; P <0.001) and were less often referred for surgery (3.7% vs. 4.9%; P = 0.03). No differences in deaths from repeat myocardial infarction, stroke, and/or composite endpoint (major adverse cardiac and cerebrovascular events MACCE) were noted. However, suffering from ACS in 2020 (June-October) was a risk factor for mortality based on multivariable analysis. CONCLUSIONS: The COVID-19 pandemic affected ACS patient profile, course of treatment, and increased risk for mortality.

Bookmark

View Full Paper