Key result
The onset of the COVID-19 pandemic was associated with a 45.5% decrease in total ACS cases and a 30.6% drop in the proportion of female patients presenting with ACS compared to equivalent weeks in 2019.
Why the study?
Global evidence showed fewer ACS cases than expected during the COVID-19 pandemic, prompting an evaluation of ACS incidence, gender distribution, and presentation types before and after pandemic onset.
Does the COVID-19 pandemic reduce acute coronary syndrome presentations in patients presenting to the catheterization lab?
Observational (n=445)
No
Does the COVID-19 pandemic reduce acute coronary syndrome presentations in patients presenting to the catheterization lab?
Effect estimate: 45.5% decrease
Absolute Event Rate: 79% vs 145%
The COVID-19 pandemic was associated with a significant decrease in ACS presentations, particularly among women, and a relative increase in STEMI presentations with higher cardiac biomarkers, suggesting delayed presentation and increased severity.
May signal pandemic-related ACS presentation delays, especially in women; hypothesis-generating for disparities and requires prospective validation.
Background: Global evidence has emerged showing fewer Acute Coronary Syndrome (ACS) cases than expected during the COVID-19 pandemic. Our study aims to evaluate the incidence of ACS before and after the onset of the COVID-19 pandemic and analyze differences in gender distribution, and type of presentation. Methods: This is a retrospective study of 997 patients who presented to Huntsville Hospital's catheterization lab for elective and emergency catheterization for ACS and non-ACS during a four-week period from February 26, 2020, to March 10, 2020, and from March 25, 2020, to April 8, 2020, and compared with the equivalent weeks in 2019. Results: We report a 45.5% decrease in ACS cases presenting during the COVID-19 pandemic between March 25, 2020, to April 8, 2020 compared to equivalent weeks in 2019, with a significant drop in percentage of female patients presenting by 30.6%. Upsurge in STEMI cases and a drop in NSTEMI cases was observed during the COVID pandemic compared to 2019. Conclusions: Patients presenting after the onset of the pandemic had elevated cardiac markers, representing higher severity and potentially presenting later in the disease course. The number of total ACS cases and percentage of females presenting to the catheterization lab before the COVID surge (February/March 2019 and 2020) almost remained stable. This comparison data provides validity that the drop in ACS case volume and females in March/April 2020 is more likely due to the pandemic and not due to improvements in overall cardiovascular health metrics. Reasons for this disparity are likely multifaceted and deserve further investigation.
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Yendrapalli et al. (2022) conducted an observational in Acute Coronary Syndrome (n=445). COVID-19 pandemic onset vs. Pre-pandemic equivalent weeks in 2019 was evaluated on Total ACS cases (45.5% decrease). The onset of the COVID-19 pandemic was associated with a 45.5% decrease in total ACS cases and a 30.6% drop in the proportion of female patients presenting with ACS compared to equivalent weeks in 2019.
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