Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

• DOI: 10.1016/j.ijcard.2021.03.063
• Publication Date: 2021-03-29T17:24:49Z
• Authors: Fabrizio D'Ascenzo; Ovidio De Filippo; Andrea Borin; Lucia Barbieri; Marianna Adamo; Nuccia Morici; Alessandra Truffa...; Mario Iannaccone; Gabriele Crimi; Luca Gaido; Pier Paolo Bocchino; Carlo Andrea Pivato; Gianluca Campo; Daniela Trabattoni; Alaide Chieffo; Nicola Gaibazzi; Filippo Angelini; Andrea Rubboli; Andrea Rognoni; Giuseppe Musumeci; Fabrizio Ugo; Sebastiano Gili; Bernardo Cortese; Paolo Vadalà; Veronica Dusi; Guglielmo Gallone; Giuseppe Patti; Gaetano Maria de ...
• Keywords: Acute coronary syndromes; Cardiovascular outcomes; COVID-19; SARS-CoV-2; Acute coronary syndromes, Cardiovascular outcomes, COVID-19, Hospital Mortality, Hospitals; 610; COVID-19; Cardiovascular outcome; Article; Hospitals; 3. Good health; Italy; Humans; Acute coronary syndrome; Hospital Mortality; Registries; Acute Coronary Syndrome; Pandemics; Acute coronary syndromes; COVID-19; Cardiovascular outcomes; Hospital Mortality; Hospitals; Humans; Italy; Pandemics; Registries; SARS-CoV-2; Acute Coronary Syndrome; COVID-19

The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined.Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1-February 19, 2020) and previous-year control periods (February 20-May 3, 2019). ACS patients with Covid-19 were further compared with those without.Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients.ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.