International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
Thomas A Kite1, Peter F Ludman2, Chris P Gale3
1Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Insights
Patients with acute coronary syndrome (ACS) and COVID-19 infection experienced longer delays in care and higher in-hospital mortality. Cardiogenic shock significantly contributed to worse outcomes in STEMI patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Concurrent coronavirus disease 2019 (COVID-19) infection is linked to worse outcomes in acute coronary syndrome (ACS) patients.
- The underlying mechanisms for these adverse outcomes remain unclear.
- This study investigates the impact of COVID-19 on ACS patient demographics, angiographic findings, and in-hospital outcomes.
Purpose of the Study:
- To report the characteristics and in-hospital outcomes of patients with ACS and COVID-19.
- To compare these outcomes with historical cohorts from before the COVID-19 pandemic.
- To identify factors contributing to adverse events in this patient population.
Main Methods:
- Data collected from 55 international centers via the prospective COVID-ACS Registry (March-July 2020).
- Included patients with confirmed COVID-19 or high clinical suspicion undergoing angiography for ACS.
- Compared outcomes (mortality, MI, heart failure, stroke, revascularization, stent thrombosis) with national pre-COVID-19 databases (MINAP 2019, BCIS 2018-2019).
Main Results:
- COVID-19 ACS patients had significantly prolonged symptom-to-admission times compared to pre-COVID-19 cohorts.
- In-hospital mortality was substantially higher in COVID-19 ACS patients (STEMI: 22.9% vs. 5.7%; NSTE-ACS: 6.6% vs. 1.2%).
- Cardiogenic shock occurred more frequently in COVID-STEMI patients (20.1% vs. 8.7%) and was a major contributor to mortality.
Conclusions:
- COVID-19-positive ACS patients present later and experience increased in-hospital mortality.
- Higher rates of cardiogenic shock significantly worsen outcomes in STEMI patients with COVID-19.
- These findings highlight the critical impact of the COVID-19 pandemic on ACS management and outcomes.
Background:
Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear.
Objectives:
The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre-COVID-19 cohorts.
Methods:
From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re-myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre-COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019).
Results:
In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001).
Conclusions:
In this multicenter international registry, COVID-19-positive ACS patients presented later and had increased in-hospital mortality compared with a pre-COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.
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