Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
West China Hospital, Sichuan University, Chengdu, China.
BMC Cardiovasc Disord. 2022 May 25;22(1):242. doi: 10.1186/s12872-022-02680-z.
The COVID-19 outbreak represents a significant challenge to international health. Several studies have reported a substantial decrease in the number of patients attending emergency departments with acute coronary syndromes (ACS) and there has been a concomitant rise in early mortality or complications during the COVID-19 pandemic. A modified management system that emphasizes nearby treatment, safety, and protection, alongside a closer and more effective multiple discipline collaborative team was developed by our Chest Pain Center at an early stage of the pandemic. It was therefore necessary to evaluate whether the newly adopted management strategies improved the clinical outcomes of ACS patients in the early stages of the COVID-19 pandemic.
Patients admitted to our Chest Pain Center from January 25th to April 30th, 2020 based on electronic data in the hospitals ACS registry, were included in the COVID-19 group. Patients admitted during the same period (25 January to 30 April) in 2019 were included in the pre-COVID-19 group. The characteristics and clinical outcomes of the ACS patients in the COVID-19 period group were compared with those of the ACS patients in the pre-COVID-19 group. Multivariate logistic regression analyses were used to identify the risk factors associated with clinical outcomes.
The number of patients presenting to the Chest Pain Center was reduced by 45% (p = 0.01) in the COVID-19 group, a total of 223 ACS patients were included in the analysis. There was a longer average delay from the onset of symptom to first medical contact (FMC) (1176.9 min vs. 625.2 min, p = 0.001) in the COVID-19 period group compared to the pre-COVID-19 group. Moreover, immediate percutaneous coronary intervention (PCI) (80.1% vs. 92.3%, p = 0.008) was performed less frequently on ACS patients in the COVID-19 group compared to the pre-COVID-19 group. However, more ACS patients received thrombolytic therapy (5.8% vs. 0.6%, p = 0.0052) in the COVID-19 group than observed in the pre-COVID-19 group. Interestingly, clinical outcome did not worsen in the COVID-19 group when cardiogenic shock, sustained ventricular tachycardia, ventricular fibrillation or use of mechanical circulatory support (MCS) were compared against the pre-COVID-19 group (13.5% vs. 11.6%, p = 0.55). Only age was independently associated with composite clinical outcomes (HR = 1.3; 95% CI 1.12-1.50, p = 0.003).
This retrospective study showed that the adverse outcomes were not different during the COVID-19 pandemic compared to historical control data, suggesting that newly adopted management strategies might provide optimal care for ACS patients. Larger sample sizes and longer follow-up periods on this issue are needed in the future.
COVID-19 疫情对国际卫生构成了重大挑战。多项研究报告称，前往急诊科就诊的急性冠状动脉综合征 (ACS) 患者数量大幅减少，并且在 COVID-19 大流行期间，早期死亡率或并发症有所增加。我们的胸痛中心在大流行早期制定了一项经过修改的管理系统，该系统强调就近治疗、安全和保护，并建立了更密切、更有效的多学科协作团队。因此，有必要评估新采用的管理策略是否改善了 COVID-19 大流行早期 ACS 患者的临床结局。
根据医院 ACS 登记处的电子数据，将 2020 年 1 月 25 日至 4 月 30 日期间入住我院胸痛中心的患者纳入 COVID-19 组。将 2019 年同期（1 月 25 日至 4 月 30 日）入住的患者纳入 COVID-19 前组。比较 COVID-19 组与 COVID-19 前组 ACS 患者的特征和临床结局。采用多变量 logistic 回归分析确定与临床结局相关的危险因素。
COVID-19 组胸痛中心就诊人数减少 45%（p=0.01），共纳入 223 例 ACS 患者。与 COVID-19 前组相比，COVID-19 组患者从症状发作到首次医疗接触（FMC）的平均延迟时间更长（1176.9 分钟 vs. 625.2 分钟，p=0.001）。此外，与 COVID-19 前组相比，COVID-19 组接受直接经皮冠状动脉介入治疗（PCI）的 ACS 患者比例较低（80.1% vs. 92.3%，p=0.008）。然而，COVID-19 组接受溶栓治疗的 ACS 患者比例（5.8% vs. 0.6%，p=0.0052）高于 COVID-19 前组。有趣的是，与 COVID-19 前组相比，COVID-19 组的心源性休克、持续性室性心动过速、心室颤动或使用机械循环支持（MCS）的患者临床结局并未恶化（13.5% vs. 11.6%，p=0.55）。只有年龄与复合临床结局独立相关（HR=1.3；95%CI 1.12-1.50，p=0.003）。
这项回顾性研究表明，与历史对照数据相比，COVID-19 大流行期间的不良结局并无不同，这表明新采用的管理策略可能为 ACS 患者提供最佳治疗。未来需要对此问题进行更大样本量和更长随访时间的研究。
