Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, México.
Department of Cardiology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
QJM. 2021 Nov 13;114(9):642-647. doi: 10.1093/qjmed/hcab013.
COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS).
To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared.
Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period.
A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different.
Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.
COVID-19 对医疗系统组织提出了挑战，需要快速调整诊断/治疗途径，以治疗急性冠状动脉综合征（ACS）等时间依赖性疾病的患者。
描述 COVID-19 大流行宣布前后 ACS 住院、管理和并发症发生率。
生态回顾性研究。方法：我们分析了来自四大洲 17 个国家的 29 个心脏中心的所有年龄大于 18 岁的 ACS 住院患者的聚合流行病学数据，时间跨度为 2019 年 12 月 1 日至 2020 年 4 月 15 日。2018 年 12 月至 2019 年 4 月的数据用作历史对照期。
ACS 住院患者每周数量呈显著下降趋势（20.2%；95%置信区间 [1.6，35.4]，P=0.04）。4 月第二周的发病率下降了 54%（发病率比：0.46，95%CI [0.36，0.58]），与 2019 年同期相比也有显著差异（分别为 3 月和 4 月，发病率比：0.56，95%CI [0.48，0.67]；0.43，95%CI [0.32，0.58]，p<0.001）。在大流行期间，报告了 STEMI 患者的门球时间、门针时间和总缺血时间显著增加（所有 P<0.04）。最后，机械并发症患者的比例更高（1.98% vs. 0.98%；P=0.006），而 GRACE 风险评分无差异。
我们的研究结果证实，COVID-19 大流行与 ACS 住院率显著下降、总缺血时间增加以及国际范围内机械并发症发生率升高有关。
