Impact of the COVID-19 pandemic on acute coronary syndromes

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• The first wave of the COVID-19 pandemic presented unprecedented challenges to healthcare systems globally.
• Understanding its impact on time-sensitive cardiovascular emergencies like acute coronary syndromes (ACS) is crucial.

Purpose of the Study:

• To evaluate the effect of the initial COVID-19 wave on ACS incidence.
• To assess delays in seeking medical attention for ST-segment elevation myocardial infarction (STEMI) during the pandemic.
• To identify patient-related reasons for delayed emergency medical contact during the COVID-19 pandemic.

Main Methods:

• A comparative study design was employed, contrasting ACS patients undergoing percutaneous coronary intervention (PCI) during the first COVID-19 wave with historical control groups from 2019 and pre-pandemic periods.
• The primary outcome was the difference in delay from symptom onset to first medical contact for STEMI patients.
• Secondary outcomes included ACS incidence rates and patient-reported reasons for delayed emergency service calls, gathered via questionnaire.

Main Results:

• A significant increase in the delay from symptom onset to first medical contact was observed for STEMI patients during the COVID-19 pandemic (112 min vs. 60 min, p=0.049).
• The incidence rate of ACS was found to be lower during the COVID-19 period (Incidence Rate Ratio: 0.6; 95% CI: 0.449–0.905).
• Patients cited fear of contracting/spreading COVID-19 and concerns about burdening the healthcare system as primary reasons for delaying emergency calls.

Conclusions:

• The first wave of the COVID-19 pandemic was associated with prolonged delays in seeking emergency medical care for STEMI.
• A notable decrease in ACS incidence was recorded during this period.
• Patients exhibited a higher threshold for seeking help due to pandemic-related anxieties.