Key result
The COVID-19 pandemic periods were not associated with a significant change in the primary composite outcome of death, heart failure, or sustained ventricular arrhythmia among NSTEMI patients compared to the pre-pandemic period.
Why the study?
While the COVID-19 pandemic was associated with decreased ACS incidence and worsened outcomes, few studies have addressed its effects on NSTEMI beyond the initial phases.
Does admission during the COVID-19 pandemic alter the management and outcomes of NSTEMI patients compared to the pre-pandemic period?
Cohort (n=250)
No
Does admission during the COVID-19 pandemic alter the management and outcomes of NSTEMI patients compared to the pre-pandemic period?
Odds Ratio: 0.85
Absolute Event Rate: 35.4% vs 39.1%
p-value: p=0.68
During the first two years of the COVID-19 pandemic, NSTEMI management became more efficient with reduced door-to-angiography times and length of stay, without worsening clinical outcomes.
Supports efficient NSTEMI pathways in crises without outcome compromise; leaves open whether adaptations reflect sustainable practice shifts.
OBJECTIVE: The COVID-19 pandemic has been associated with decreased incidence of acute coronary syndrome with worsened outcomes. Few studies have addressed the effects beyond the initial phases of the pandemic. This study elucidated the incidence, clinical characteristics, management, and outcomes of NSTEMI at a tertiary referral center from sample time periods of 2019-2022. METHODS: This study included consecutive NSTEMI patients from March 14-May 9, 2019-2022. Variables included baseline characteristics, clinical features on arrival, management strategy, time parameters, and adverse outcomes. The primary outcome was defined as death, heart failure requiring diuretics, and/or sustained ventricular arrhythmia. RESULTS: This study comprised 250 patients of whom 181 who were admitted during the COVID-19 outbreak. Baseline characteristics were similar among groups. There was a reduction in door-to-angiography time from 29 h in 2019 to 19 h in 2020 [p = 0.01] and 20 h in 2021 [p = 0.02]. PCI intervention increased from 31.8% in 2019% to 50.0% in 2020 [p = 0.05] and 54.7% in 2021 [p < 0.01]. Median length-of-stay (LOS) was reduced from 3 days in 2019 to 2 days in 2020 [p = 0.03]. There was no significant change in outcomes in COVID-19 cohorts compared to control year. CONCLUSIONS: NSTEMI patients during the first 2 years of the COVID-19 pandemic were associated with reduced door-to-angiography times and increased percutaneous coronary intervention (PCI), and patients in year one were associated with reduced LOS. This study suggests that NSTEMI may be managed more efficiently thus reducing hospital bed utilization and potential costs.
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Hyder et al. (2022) conducted a cohort in Non-ST Elevated Myocardial Infarction (NSTEMI) (n=250). COVID-19 pandemic period (2020-2022) vs. Pre-COVID-19 period (2019) was evaluated on Composite in-hospital outcome (death, acute CHF requiring diuretics, and/or sustained ventricular tachycardia/fibrillation) (OR 0.85, p=0.68). The COVID-19 pandemic periods were not associated with a significant change in the primary composite outcome of death, heart failure, or sustained ventricular arrhythmia among NSTEMI patients compared to the pre-pandemic period.
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