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Impact of COVID 19 pandemic in acute coronary syndrome admissions and management
Session:
CO 14 - Doença coronária
Speaker:
Bruno Castilho
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bruno Miranda Castilho; Ana Rita Veiga; Ana Rita Moura; Mariana Saraiva; Nuno Craveiro; Ana Filipa Damásio; Kevin Domingues; Vitor Martins
Abstract
<h1><span style="font-size:16px"><u><strong><span style="font-family:"Calibri",sans-serif">Impact of COVID 19 pandemic in acute coronary syndrome admissions and management</span></strong></u></span></h1> <p><u>INTRODUCTION</u></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">COVID-19 has been declared a pandemic on 11 March 2020 and it is placing an enormous burden on the Portuguese healthcare system. Recent international studies suggest that this epidemic had a vast deleterious effect on the management of acute coronary syndromes (ACS) resulting in significant reduction of ACS admissions and an increase in complication rates and mortality. The aim of this study is to investigate the impact of the pandemic on the number of admissions, management and outcomes of ACS. </span></span></p> <p><u><span style="font-family:Calibri,sans-serif"><span style="font-size:14.6667px">METHODS</span></span></u></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of patients admitted due to ACS between 1 March and 31 December of 2019 and in the same period of 2020 (COVID 19 pandemic), in a district hospital. The two groups were compared according to the number of admissions, type of ACS, time from admission to first ECG in patients presenting to the emergency department (ED) with chest pain, Killip class and LVEF (left ventricular ejection fraction) on admission, complications during the admission (sustained ventricular tachycardia, cardiac arrest, need of inotropic therapy and mechanical ventilation) and mortality.</span></span></p> <p><u><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS</span></span></u></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 227 patients were included, predominantly men (71.8%) and with a mean age of 67.8±12.7 years. During the period of 2020 there was a significant decrease (41%) in the number of admissions due to ACS (84 <em>versus</em> 143 in 2019). The proportion of ST elevation myocardial infarction (STEMI) was similar (34.2% in 2019 <em>versus </em>34.5% in 2020, <em>p=</em>0.54). Time to ECG since admission to the ED, in patients presenting with chest pain, was significantly higher in 2020 (26.7±18.9 <em>versus</em> 19.4±10.7 minutes, <em>p =0,02</em>). The proportion of reduced LVEF (<50%) on admission was slightly (but not significantly) lower in the 2020 group (45.1% vs 50.7%, <em>p=</em>0,49). The probability of evolution in Killip > 1 was similar on both groups (11.8% vs 10.5%, <em>p=</em>,45), such as the rate of complications (sustained ventricular tachycardia, inotropic therapy; mechanical ventilation; cardiac arrest), (17.9 % in 2020 vs 15.4% in 2019, <em>p=</em>0,39). In-hospital mortality was slightly lower in 2020, without statistical significance (3.6 vs 4.9%, <em>p=</em>0,28).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSION</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our results are in trend with international studies that suggest a significant decrease in ACS admissions during the COVID 19 pandemic and a more problematic management of these patients (particularly in the ED), in this case reflected by the significantly increased time to first ECG in the period of 2020. However, the rate of complications, Killip class, LVEF at admission and mortality rates were not significantly different, suggesting that patients did not present with more severe disease and that, despite the challenges associated with the pandemic, hospitals managed to provide adequate patient care. Studies of out-of-hospital mortality are needed to clarify the impact of ACS mortality in this setting.</span></span></p>
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