Key result
The COVID-19 pandemic period, managed with newly adopted strategies, did not significantly worsen the composite clinical outcomes of in-hospital death, cardiogenic shock, sustained VT/VF, or use of mechanical circulatory support in ACS patients compared to the pre-pandemic period (13.5% vs. 11.6%, p=0.55).
Why the study?
To evaluate whether newly adopted management strategies emphasizing nearby treatment, safety, protection, and multidisciplinary collaboration improved clinical outcomes of ACS patients during the COVID-19 pandemic.
Does a modified management strategy during the COVID-19 pandemic prevent worse composite clinical outcomes in patients with acute coronary syndrome compared to pre-pandemic standard care?
Cohort (n=223)
No
Does a modified management strategy during the COVID-19 pandemic prevent worse composite clinical outcomes in patients with acute coronary syndrome compared to pre-pandemic standard care?
Absolute Event Rate: 13.5% vs 11.6%
p-value: p=0.55
Modified ACS protocols during COVID-19 maintained outcomes despite fewer presentations; leaves open need for prospective validation.
BACKGROUND: The COVID-19 outbreak represents a significant challenge to international health. Several studies have reported a substantial decrease in the number of patients attending emergency departments with acute coronary syndromes (ACS) and there has been a concomitant rise in early mortality or complications during the COVID-19 pandemic. A modified management system that emphasizes nearby treatment, safety, and protection, alongside a closer and more effective multiple discipline collaborative team was developed by our Chest Pain Center at an early stage of the pandemic. It was therefore necessary to evaluate whether the newly adopted management strategies improved the clinical outcomes of ACS patients in the early stages of the COVID-19 pandemic. METHODS: Patients admitted to our Chest Pain Center from January 25th to April 30th, 2020 based on electronic data in the hospitals ACS registry, were included in the COVID-19 group. Patients admitted during the same period (25 January to 30 April) in 2019 were included in the pre-COVID-19 group. The characteristics and clinical outcomes of the ACS patients in the COVID-19 period group were compared with those of the ACS patients in the pre-COVID-19 group. Multivariate logistic regression analyses were used to identify the risk factors associated with clinical outcomes. RESULTS: The number of patients presenting to the Chest Pain Center was reduced by 45% (p = 0.01) in the COVID-19 group, a total of 223 ACS patients were included in the analysis. There was a longer average delay from the onset of symptom to first medical contact (FMC) (1176.9 min vs. 625.2 min, p = 0.001) in the COVID-19 period group compared to the pre-COVID-19 group. Moreover, immediate percutaneous coronary intervention (PCI) (80.1% vs. 92.3%, p = 0.008) was performed less frequently on ACS patients in the COVID-19 group compared to the pre-COVID-19 group. However, more ACS patients received thrombolytic therapy (5.8% vs. 0.6%, p = 0.0052) in the COVID-19 group than observed in the pre-COVID-19 group. Interestingly, clinical outcome did not worsen in the COVID-19 group when cardiogenic shock, sustained ventricular tachycardia, ventricular fibrillation or use of mechanical circulatory support (MCS) were compared against the pre-COVID-19 group (13.5% vs. 11.6%, p = 0.55). Only age was independently associated with composite clinical outcomes (HR = 1.3; 95% CI 1.12-1.50, p = 0.003). CONCLUSION: This retrospective study showed that the adverse outcomes were not different during the COVID-19 pandemic compared to historical control data, suggesting that newly adopted management strategies might provide optimal care for ACS patients. Larger sample sizes and longer follow-up periods on this issue are needed in the future.
No takes yet. Share an insight, caveat, or question.
Zuo et al. (2022) conducted a cohort in Acute coronary syndrome (ACS) (n=223). COVID-19 pandemic period vs. Pre-COVID-19 period was evaluated on Composite of in-hospital death, cardiogenic shock, sustained VT/VF, and use of mechanical circulatory support (p=0.55). The COVID-19 pandemic period, managed with newly adopted strategies, did not significantly worsen the composite clinical outcomes of in-hospital death, cardiogenic shock, sustained VT/VF, or use of mechanical circulatory support in ACS patients compared to the pre-pandemic period (13.5% vs. 11.6%, p=0.55).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: