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Acute coronary syndrome in a pandemic: what about NSTEMI?
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Joana Silva Ferreira
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Joana Silva Ferreira; Marta Ferreira Fonseca; Sara Gonçalves; José Maria Farinha; Ana Fátima Esteves; António Pinheiro Candjonjo; Rui Coelho; Cátia Costa; Rui Caria
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Background</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">: The ongoing, and still growing, COVID-19 pandemic has placed an extra burden on health care systems. In an attempt to cope with it, several <span style="font-family:"Calibri Light",sans-serif">measures have been adopted in society and in health care institutions, including temporary suspension of elective medical activity and the creation of COVID and COVID-free circuits within hospitals.</span> Data from various centres, including in Portugal, showed a reduction in admissions for ST-elevation myocardial infarction during the first COVID-19 outbreak.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Purpose</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">: To assess the impact of this pandemic on the pattern of admissions and treatment of patients with non-ST-elevation myocardial infarction (NSTEMI) in a Portuguese district hospital. </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">: A retrospective study was conducted in the Cardiology Department of a district hospital capable of performing 24h percutaneous coronary intervention (PCI). We analysed admissions for acute coronary syndrome (ACS) after the detection of the first COVID-19 case in Portugal (2<sup>nd</sup> March to 31<sup>st</sup> December – COVID period), compared them with exactly the same period in 2019 (2<sup>nd</sup> March to 31<sup>st</sup> December 2019 – control period) and assessed their association with the evolution of the pandemic. In particular for NSTEMI, we compared the number of admissions, patient characteristics, time from symptom onset (SO) to presentation in the emergency room (ER) and to PCI, as well as their outcomes. </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">: During the COVID period, there were 253 admissions for ACS, while in the control period there had been 290, with a mean of 6 hospitalizations per week (not differing from the control: 7 admissions/week, p=0.111). There was no correlation between the weekly number of admissions for any type of ACS and the number of national weekly COVID-19 cases, hospitalizations or deaths.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Analysing patients admitted for NSTEMI, there were no significant differences between the COVID (n=120) and control group (n=118) in demographics (median age of 71) and baseline characteristics. Their presentation also did not differ: median time from SO to the ER was 3 hours, with 8% of patients presenting in Killip class ≥III (p>0.05 for both). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">In both groups, around 97% of patients underwent coronary angiography. However, time from ER presentation to PCI was higher in the COVID period (median of 45 vs 24 hours, p<0.001).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Outcomes did not differ between groups, with a median length of hospital stay of 4 days and in-hospital mortality rate of 4% (p>0.05 for both). </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri Light",sans-serif">: Our study suggests that the reduction in admissions for ACS during COVID-19 outbreaks is not universal and does not seem related to the national incidence of COVID-19. Particularly for NSTEMI, time from patient admission at the ER to coronary angiography increased but it did not lead to worse outcomes. This delay might be related to a policy of testing for COVID-19 before all non-emergent procedures.</span></span></span></span></p>
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