Key result
The COVID-19 pandemic isolation periods were not associated with significant changes in the incidence of total ACS (p=0.219), STEMI, or NSTEMI/UA compared to the pre-isolation period.
Why the study?
The COVID-19 pandemic was associated with a worrisome decrease in ACS cases, prompting investigation into the trajectory of ACS following the relaxation of isolation orders and public service education.
Does the implementation and subsequent relaxation of COVID-19 isolation orders affect the incidence of acute coronary syndrome cases requiring cardiac catheterization?
Observational (n=315)
No
Does the implementation and subsequent relaxation of COVID-19 isolation orders affect the incidence of acute coronary syndrome cases requiring cardiac catheterization?
p-value: p=0.219
The incidence of ACS cases requiring cardiac catheterization did not significantly change between pre-isolation, strict isolation, and relaxed isolation periods of the COVID-19 pandemic at a single academic center.
ACS presentations rebounded after isolation relaxation; confirms pandemic-related care-seeking delays and leaves open optimal public messaging strategies.
Background: The COVID-19 pandemic was associated with a worrisome decrease in acute coronary syndrome (ACS) cases. We sought to investigate the trajectory of ACS following the relaxation of isolation orders and public service education. Hypothesis: We hypothesized that during the COVID-19 pandemic, ACS cases would decrease during the period of strict isolation and thereafter increase, illustrating a “rebound effect”, during the period of relaxed isolation. Methods: All adults with concern for ACS requiring cardiac catheterization at one academic center from 22 December 2019 to 13 June 2020 were included. Cases were designated as ST-elevation myocardial infarction (STEMI), STEMI activation, out-of-hospital cardiac arrest (OHCA), Non-STEMI/unstable angina (NSTEMI/UA), and/or total ACS. 18 December - 14 March, 15 March - 9 May, and 10 May - 13 June were designated as pre-isolation COVID-19 (piC), strict isolation COVID-19 (siC), and relaxed isolation COVID-19 (riC), respectively. Fisher’s exact test was used to compare average cases per week in piC vs. siC and siC vs. riC. One-way ANOVA was used to compare cases across piC, siC, and riC together. Analysis was completed with STATA/MP 16.1. Results: 315 cases concerning for ACS requiring cardiac catherization lab activation were included. When comparing piC with siC and siC with riC, there were no significant differences in STEMI, STEMI activation, OHCA, NSTEMI/UA, or total ACS. When compared across piC, siC, and riC simultaneously there were no significant differences in STEMI (p=0.426), STEMI activation (p=0.172), OHCA (p=0.167), NSTEMI/UA (p=0.362), and total ACS (p=0.219). Total ACS, STEMI activation, NSTEMI/UA, and OHCA exhibited a trend towards a rebound effect (Graph). Conclusions: There were no significant changes in the incidence of total ACS, OHCA, STEMI, STEMI activation, or NSTEMI/UA between pre-isolation, strict isolation, and relaxed isolation periods of the COVID-19 pandemic.
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Desai et al. (2020) conducted an observational in Acute coronary syndrome (n=315). COVID-19 pandemic isolation periods vs. Pre-isolation period was evaluated on Incidence of total ACS cases (p=0.219). The COVID-19 pandemic isolation periods were not associated with significant changes in the incidence of total ACS (p=0.219), STEMI, or NSTEMI/UA compared to the pre-isolation period.
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