Toušek Petr, Kocka Viktor, Masek Petr, Tuma Petr, Neuberg Marek, Novackova Markéta, Kroupa Josef, Bauer David, Motovska Zuzana, Widimsky Petr
Department of Cardiology, Third Faculty of Medicine, Charles University, University Hospital Královské Vinohrady, 100 34 Prague, Czech Republic.
Medtronic Czechia, Partner of INTERCARDIS Project, 190 00 Prague, Czech Republic.
J Clin Med. 2020 Dec 24;10(1):24. doi: 10.3390/jcm10010024.
The COVID-19 pandemic presents several challenges for managing patients with acute coronary syndrome (ACS). Modified treatment algorithms have been proposed for the pandemic. We assessed new algorithms proposed by The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Acute Cardiovascular Care Association (ACCA) on patients with ACS admitted to the hospital during the COVID-19 pandemic. The COVID-19 period group (CPG) consisted of patients admitted into a high-volume centre in Prague between 1 February 2020 and 30 May 2020 ( = 181). The reference group (RG) included patients who had been admitted between 1 October 2018 and 31 January 2020 ( = 834). The proportions of patients with different types of ACS admitted before and during the pandemic did not differ significantly: in all ACS patients, KILLIP III-IV class was present in 13.9% in RG and in 9.4% of patients in CPG ( = 0.082). In NSTE-ACS patients, the ejection fraction was lower in the CPG than in the RG (44.7% vs. 50.7%, respectively; < 0.001). The time from symptom onset to first medical contact did not differ between CPG and RG patients in the respective NSTE-ACS and STEMI groups. The time to early invasive treatment in NSTE-ACS patients and the time to reperfusion in STEMI patients were not significantly different between the RG and the CPG. In-hospital mortality did not differ between the groups in NSTE-ACS patients (odds ratio in the CPG 0.853, 95% confidence interval (CI) 0.247 to 2.951; = 0.960) nor in STEMI patients (odds ratio in CPG 1.248, 95% CI 0.566 to 2.749; = 0.735). Modified treatment strategies for ACS during the COVID-19 pandemic did not cause treatment delays. Hospital mortality did not differ.
2019冠状病毒病（COVID-19）大流行给急性冠状动脉综合征（ACS）患者的管理带来了诸多挑战。针对这一疫情，已提出了改良的治疗算法。我们评估了欧洲经皮心血管介入协会（EAPCI）和急性心血管护理协会（ACCA）针对COVID-19大流行期间入院的ACS患者所提出的新算法。COVID-19时期组（CPG）由2020年2月1日至2020年5月30日期间入住布拉格一家大型中心的患者组成（ = 181）。参考组（RG）包括2018年10月1日至2020年1月31日期间入院的患者（ = 834）。大流行之前和期间入院的不同类型ACS患者的比例没有显著差异：在所有ACS患者中，RG组中13.9%的患者为KILLIP III-IV级，CPG组中这一比例为9.4%的患者（ = 0.082）。在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者中，CPG组的射血分数低于RG组（分别为44.7%和50.7%； < 0.001）。在各自的NSTE-ACS和ST段抬高型心肌梗死（STEMI）组中，CPG组和RG组患者从症状发作到首次医疗接触的时间没有差异。RG组和CPG组在NSTE-ACS患者中进行早期侵入性治疗的时间以及在STEMI患者中进行再灌注的时间没有显著差异。NSTE-ACS患者组间的住院死亡率没有差异（CPG组的比值比为0.853，95%置信区间（CI）为0.247至2.951； = 0.960），STEMI患者组间也没有差异（CPG组的比值比为1.248，95%CI为0.566至2.749； = 0.735）。COVID-19大流行期间针对ACS的改良治疗策略没有导致治疗延迟。住院死亡率没有差异。
