Impact of the COVID-19 Pandemic on Patients With Acute Coronary Syndrome: A Tertiary Center Experience With Primary Percutaneous Intervention and Early Invasive Strategy

Abstract

OBJECTIVE:  This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on patients with acute coronary syndrome (ACS). METHODS: This retrospective longitudinal cohort study analysed ACS patients admitted in a large tertiary center in 2019 (pre-pandemic) and 2020 (pandemic). The primary endpoint was mortality from myocardial infarction; secondary endpoints were death from any causes, including COVID-related complications, stroke, and coronary artery bypass graft surgery. RESULTS: There were 489 ACS patients admitted in 2020, and 614 in 2019, representing a 21% reduction (p=0.001). Male patients comprised 73% of the patients. Only eight were polymerase chain reaction (PCR)-confirmed positive COVID-19 patients. The mean time to presentation from the time of onset of symptoms in acute ST-elevation myocardial infarction cases was 48±16 in 2020 (vs. 4±3 h in 2019); this significant delay was observed in more than 50% of patients (p=0.0001). Mortality due to ACS in 2020 doubled, with eight patients confirmed dead during or within 30 days of admission, with none of the deaths related to COVID-19. The incidence of stroke (p=0.01) and coronary artery (p=0.0001) bypass was also high in 2020. CONCLUSION: We found a statistically significant increase in the mortality related to myocardial infarction. Despite timely interventions, patients presented late and were worse than in the non-pandemic period.