A Retrospective Single Centre Analysis of the Incidence of Hospital Admission for Acute Coronary Syndrome During the COVID-19 Pandemic

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic due to ‘coronavirus disease 2019’ (COVID-19) that has led to millions of deaths. This may have resulted in a change in the rate of admissions for other potentially life-threatening conditions such as acute coronary syndromes (ACS). Therefore, we investigated the incidence of ACS admissions during the current pandemic and compared it to a similar period the year before. Methods: This was a retrospective analysis of all patients admitted to a tertiary cardiology centre with ACS between February 2019 and the end of April 2019 (pre-COVID) that was compared with admissions between the same three months in 2020 (post-COVID). The main outcomes of interest were to evaluate any potential reduction of ACS admissions during the pandemic or change in mortality. In addition, we evaluated the rate of patients proceeding to coronary angiography (CAG). Results: During the post-COVID period, only 200 patients were admitted with ACS as compared to 331 patients during the pre-COVID period (39.6% reduction; 95% confidence interval (CI): 34% - 44%; p<0.01). A reduction in the percentage of patients proceeding to CAG was also noted (253 patients during the pre-COVID period compared to only 134 patients in the post-COVID period (76.4% vs 67.0%; p = 0.02)) but no associated reduction of primary percutaneous coronary intervention was noted. No increase in in-hospital mortality was noted between the pre-COVID and post-COVID groups (1.5% vs 1% respectively; p = 0.62). Conclusion: There was a significant reduction in admissions for ACS in the post-COVID period compared to a similar period prior. There was also a reduction in the overall invasive management of ACS, with less CAG performed but no associated reduction in the rate of PPCI. The in-hospital mortality rate was similar in the two groups.