SPC365

The missing myocardial infarctions in the COVID-19 pandemic: a report of a tertiary center

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Inês Sofia Pereira Oliveira

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.6 Acute Coronary Syndromes - Clinical
Session Type: Posters
FP Number: ---
Authors: Inês Pereira Oliveira; Mariana Silva; Ana Rita Moura; Gualter Silva; Ana Neto; Pedro Queirós; Mariana Brandão; Diogo Ferreira; Daniel Caeiro; Adelaide Dias; João Azevedo; Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: The COVID-19 outbreak led to a global decrease in the number of acute coronary syndrome (ACS) admissions, which may result in an increase in early and late-infarct related morbidity and mortality</span></span></span>.</span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To characterize the clinical and epidemiological profile of a cohort of patients (pts) admitted for myocardial infarction (MI) during the COVID-19 pandemic, trying to understand the differences from the pre-COVID-19 equivalent period.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Unicentric, retrospective analysis of pts with type 1 MI admitted to a Cardiac Intensive Care Unit (CICU). Pts were divided in 2 groups: G1) Pre-COVID-19 (August-December 2019) and G2) COVID-19 (August-December 2020). Clinical characteristics, patient delay, ventricular function, morbidity and in-hospital mortality were analysed. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of 382 pts were included. </span></span></span>While the total number of pts admitted to CICU reduced by 10.5%, the number of MI admissions fell by 34.6% from&nbsp;August-December of the&nbsp;COVID-19 pandemic comparing with the previous year (G2: n=151 vs G1: n=231).&nbsp;<span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif">No significant differences in mean age (G2: 64.7&plusmn;12.6 years vs G1: 64.3&plusmn;12.6 years), sex (G2: n=117, 77.5% males vs G1: n=181, 78.4%) or risk factors&rsquo; prevalence. The drop in ACS admissions was mainly due to a decrease in non-ST elevation MI (NSTEMI) (G2: n=56, 37.1% vs G1: n=115, 49.8%, p=0.015), representing a reduction of 51.3%. In contrast, the number of ST-elevation MI (STEMI) decreased by only 17.0%, making most of hospitalizations (G2: n=91, 60.3% vs G1: n=110, 47.6%, p=0.016). Late admissions (&gt; 48 hours after symptom onset) significantly increased (G2: n=18, 12.4% vs G1: n= 11, 5.0%, p=0.01) and Killip-Kimball (KK) class at presentation was higher (G2: n=24, 15.9% in KK III/IV vs G1: n=12, 5.2%, p&lt;0.001). G2 also had higher maximum troponin levels (G2: 5024.1ng/L vs G1: 3156.6ng/L, p=0.008), worse left ventricular (LV) function (G2: n=53, 35.1% had moderate-severe LV function vs G1: n=42, 18.2%, p&lt;0.05) and higher rate of mechanical complications (G2: n=3, 2.0% vs G1: 0%, p=0.03). However, no significant differences in NT-proBNP levels, Q waves development, average hospital stay, treatment strategy and in-hospital mortality were&nbsp;found.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: &nbsp;A significant decline in the number of MI admissions during the COVID-19 outbreak was found, mostly NSTEMI. <span style="background-color:white">The decrease was less pronounced in STEMI, suggesting that more serious pts attended emergency services. Increased </span>pt delay, worse KK class, worse LV function and higher complication rate were found, although in-hospital mortality rate was similar.</span></span></span></span></p>