Acute Coronary Syndrome in the COVID-19 Pandemic: Reduced Cases and Increased Ischaemic Time
Nigel Sutherland1, Nalin H Dayawansa1, Benjamin Filipopoulos2
1Department of Cardiology, Northern Health, Melbourne, Vic, Australia.
Insights
The COVID-19 pandemic saw fewer acute coronary syndrome (ACS) presentations, with longer delays to treatment and increased need for revascularization. Public awareness is crucial for future pandemic waves.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Acute coronary syndrome (ACS) treatment pathways were disrupted by the pandemic.
- Understanding the pandemic's effect on ACS is vital for healthcare preparedness.
Purpose of the Study:
- To analyze the impact of the COVID-19 pandemic on ACS patient presentations.
- To compare ACS cases during the first and second pandemic waves with a pre-pandemic control period.
- To evaluate changes in treatment and outcomes for ACS patients during the pandemic.
Main Methods:
- Retrospective cohort study design.
- Inclusion of adult patients presenting with ACS.
- Comparison of three periods: pre-pandemic (2019), first wave (2020), and second wave (2020).
Main Results:
- A reduction in total ACS hospitalizations was observed during the pandemic.
- A higher proportion of ST-elevation myocardial infarctions (STEMI) presented during pandemic waves.
- Ischemic times increased, with longer delays from symptom onset to medical contact.
- Coronary angiography and revascularization rates significantly increased during pandemic waves.
Conclusions:
- The COVID-19 pandemic led to a concerning decrease in ACS presentations.
- Delayed treatment and increased revascularization needs were associated with pandemic ACS cases.
- Public health campaigns are essential to address patient-related factors during future health crises.
Background:
The COVID-19 pandemic has led to unprecedented stress on health care systems, and has affected acute coronary syndrome treatment at every step. This study aimed to examine the impact of COVID-19 on patient presentations with acute coronary syndromes during the first and second pandemic wave in Melbourne, Victoria.
Method:
A retrospective cohort study of adults presenting with cute coronary syndrome during the first pandemic wave from 1 March 2020 to 31 April 2020 and the second pandemic wave from 1 July 2020 to 31 August 2020 was compared to a control period from 1 March to 31 April 2019 at a single sub-tertiary referral centre in Melbourne, Victoria servicing a catchment area with a relatively high incidence of COVID-19 cases.
Results:
Three-hundred-and-thirty-five (335) patients were hospitalised with acute coronary syndromes across all three time periods. The total number of patients presenting with an acute coronary syndrome was reduced during the pandemic, with a higher proportion of ST elevation myocardial infarctions. Ischaemic times increased with time from symptom onset to first medical contact rising from 191 minutes in the control period to 292 minutes in the first wave (p=0.06) and 271 minutes in the second wave (p=0.06). Coronary angiography with subsequent revascularisation significantly increased from 55% in the control period undergoing revascularisation to 69% in the first wave (p<0.001) and 74% in the second wave (p<0.001).
Conclusion:
A concerning reduction in acute coronary presentations occurred during the COVID-19 pandemic, associated with longer ischaemic times and a higher proportion requiring revascularisation. It is crucial that public awareness campaigns are instituted to address the contributing patient factors in future waves.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Acute Coronary Syndrome V: Nursing Management