ABSTRACT
Background Cardiovascular complications are frequent in SARS-CoV-2 patients. The characteristics of acute coronary syndromes (ACS) in this population have not yet been reported. Purpose We aimed to report clinical characteristics and outcome of patients with and without SARS-CoV-2 infection referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. Methods We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or NSTEMI during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south and north of France), all performing primary percutaneous coronary intervention (PCI). Results The study included 237 patients (67 ± 14, 69% of male), 111 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2 associated ACS was 11% (n = 26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen >6L/min). Patients were comparable regarding medical history and risk factors, except higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs. 25.5%, P = 0.003). In SARS-CoV-2 patients, admission for cardiac arrest was more frequent (26.9% vs. 6.6%, P < 0.001), and significant coronary artery disease and culprit artery occlusion were reported in 76.5% and 92% of STEMI patients, and 88.9% and 50% of NSTEMI, respectively. PCI was performed in the same percentage of STEMI (82%) and NSTEMI (86%) cases, regardless of SARS-CoV-2 infection, but no-reflow after PCI (19.2% vs. 3.3%, P < 0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared to non-infected patients (26.9% vs. 6.2%, P < 0.001) Conclusion SARS-CoV-2 infection is frequent in ACS patients with higher incidence of coronary occlusion and no-reflow compared to non-SARS-CoV-2 ACS, which may explain the higher in-hospital mortality, despite a similar rate of PCI.
ABSTRACT
BACKGROUND: Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS: A total of 6306 patients were included. During the pandemic peak, a 13.9+/-6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min;P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min;P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%;P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020;P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.