Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Coronary Syndrome (ACS) (n=1692). Intervention: COVID-19 pandemic and post-restriction periods vs. Pre-pandemic period (2019). Primary outcome: In-hospital mortality (p=0.0006).

Q: What does this research mean for the field?

In-hospital mortality among acute coronary syndrome patients remained stable during the acute COVID-19 pandemic years but increased significantly to 7.4% in the post-restriction period of 2022. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Masaharu Nakano; Yoshiaki Mitsutake; TOMOHIRO KAWASAKI; Hideki Tashiro; Atsushi Kato; Nagisa Morikawa; SHUHEI KAWASAKI; TARO KATSUKI; Takumi Yoshiga; Kazunori Yamaji; Takashi Ishimatsu; M SASAKI; Naoki Itaya; Takaharu Nakayoshi; Ken‐ichiro Sasaki; YOSHIHIRO FUKUMOTO

doi:10.2739/kurumemedj.ms7312009

January 1, 2026The Kurume Medical JournalOpen Access

Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study

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Key result

In-hospital mortality among patients with acute coronary syndrome remained stable during the pandemic but increased significantly to 7.4% in the post-restriction period of 2022 compared to 4.0% in 2019.

Why the study?

The impact of the COVID-19 pandemic on ACS care and potential delayed effects after the acute pandemic phase in stable regional healthcare systems remained limited.

Does the COVID-19 pandemic and subsequent post-restriction period alter in-hospital mortality in patients undergoing PCI for acute coronary syndrome?

Key Points

To evaluate the impact of the COVID-19 pandemic across pre-pandemic, pandemic, and post-restriction periods on acute coronary syndrome presentation, care, and in-hospital outcomes in a stable regional healthcare system.
Conducted a retrospective, population-based observational study of 4,694 percutaneous coronary intervention (PCI) procedures, including 1,692 for acute coronary syndrome (ACS), across all four PCI-capable hospitals in Kurume City, Japan.
Compared trends across pre-pandemic (2019), pandemic (2020-2021), and post-restriction (2022) periods.
Assessed the primary endpoint of in-hospital mortality, as well as secondary endpoints including ACS subtype distribution and use of mechanical circulatory support (MCS).
Annual PCI volume and the proportion performed for ACS remained stable at 34.1%-38.6%, though the proportion of ST-segment elevation myocardial infarction (STEMI) rose in 2020 and stayed elevated in 2022 compared to 2019 (p=0.015).
In-hospital mortality among ACS patients remained steady during the pandemic years but rose significantly in 2022 (7.4% vs 2.3%-4.0%; p=0.0006), even after excluding patients with post-cardiac arrest syndrome.
Utilization of mechanical circulatory support showed no significant difference across years, while emergency medical transport times lengthened modestly.

Study Design

Type

Observational (n=1,692)

Multicenter

Yes

Structured PICO

Does the COVID-19 pandemic and subsequent post-restriction period alter in-hospital mortality in patients undergoing PCI for acute coronary syndrome?

P

Population

1,692 patients undergoing percutaneous coronary intervention for acute coronary syndrome, evaluated for in-hospital outcomes across pre-pandemic, pandemic, and post-restriction periods.

E

Exposure

Admission and PCI treatment for ACS during the COVID-19 pandemic (2020-2021) and post-restriction (2022) periods.

C

Comparator

Admission and PCI treatment for ACS during the pre-pandemic period (2019).

O

Outcome

In-hospital mortality among patients undergoing PCI for ACS.hard clinical

Main Result

Absolute Event Rate: 7.4% vs 4%

p-value: p=0.0006

Limitations

Retrospective observational study in a single regional medical area, potentially limiting generalizability
Restricted to PCI-treated ACS; conservatively managed cases and out-of-hospital deaths were not included
Lack of detailed clinical variables such as symptom-to-door time, door-to-balloon time, infarct size, and comorbidities
Inability to determine the underlying mechanisms of the increased mortality in the post-pandemic period
Retrospective observational study conducted in a single regional medical area, limiting generalizability.
Restricted to PCI-treated ACS, excluding conservatively managed patients and out-of-hospital deaths.
Lack of detailed clinical variables (symptom-onset-to-first-medical-contact time, door-to-balloon time, infarct size, laboratory data, comorbidities, COVID-19 infection status).
Inability to determine the underlying mechanisms for the increase in in-hospital mortality in the post-pandemic period.

Implication

While the acute COVID-19 pandemic did not impair emergent ACS care or short-term mortality in this robust regional system, in-hospital mortality worsened significantly in the post-restriction period, suggesting delayed cardiovascular consequences.

Abstract

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on acute coronary syndrome (ACS) care has varied widely across regions. Data from stable regional healthcare systems remain limited, particularly regarding potential delayed effects after the acute pandemic phase. METHODS: We conducted a retrospective, population-based observational study of percutaneous coronary intervention (PCI)-treated ACS in Kurume City, Japan, across three periods: pre-pandemic (2019), pandemic (2020-2021), and post-restriction (2022). PCI data were collected from all four PCI-capable hospitals in the region. The primary endpoint was in-hospital mortality among ACS patients. Secondary endpoints included ACS subtype distribution and use of mechanical circulatory support (MCS). RESULTS: A total of 4,694 PCI procedures were performed between 2019 and 2022, including 1,692 for ACS. Annual PCI volume and the proportion performed for ACS (34.1%-38.6%) remained stable. The proportion of ST-segment elevation myocardial infarction was higher in 2020 and remained elevated in 2022 compared with 2019 (p=0.015). In-hospital mortality among ACS patients was comparable during the pandemic years but increased significantly in 2022 (7.4% vs 2.3%-4.0%; p=0.0006), even after excluding post-cardiac arrest syndrome. Rates of MCS use did not differ significantly across years. Emergency medical transport times increased modestly. CONCLUSION: In this regional healthcare system, the COVID-19 pandemic did not substantially disrupt emergent coronary revascularization or worsen short-term outcomes of PCI-treated ACS during the acute phase. However, in-hospital mortality increased in the post-restriction period, suggesting delayed cardiovascular consequences of the pandemic.

Discussion

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Cite This Study

Nakano et al. (2026) conducted an observational in Acute Coronary Syndrome (ACS) (n=1,692). COVID-19 pandemic and post-restriction periods vs. Pre-pandemic period (2019) was evaluated on In-hospital mortality (p=0.0006). In-hospital mortality among patients with acute coronary syndrome remained stable during the pandemic but increased significantly to 7.4% in the post-restriction period of 2022 compared to 4.0% in 2019.

synapsesocial.com/papers/6ad0fce415427f6a8404035f https://doi.org/10.2739/kurumemedj.ms7312009

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Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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