Admissions and In-hospital Outcomes of Acute Coronary Syndromes during Corona Virus Disease 19 Pandemic in Albania

Abstract

BACKGROUND: Cardiologists and surveys from all over the world have reported an important drop in admissions of patients with acute coronary syndromes (ACS) and related coronary procedures during the outbreak of coronavirus disease 19 (COVID 19) pandemic. AIM: We investigated the impact of the COVID 19 pandemic on hospitalizations for ACS and related invasive procedures in a country with low COVID 19 incidence. METHODS: We conducted a single-center, observational retrospective study including all consecutive patients admitted for ACS in the Cardiology Department of University Hospital Center Mother Theresa from March 9, 2020 (1st day of application of social distance measures) to April 30th (period of total lockdown). Patients admitted in the same time period in 2019 served as controls. All data were collected from the medical files. Admissions were classified as ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS (NSTEACS). Total and weekly admissions and invasive procedures were assessed. Mean incidence difference (MID) in weekly ACS admissions and procedures was also calculated. RESULTS: Overall, 781 patients were included in this analysis: 321 patients (37%) were admitted during study period and 550 patients (63%) were admitted during the control period (overall reduction of 41.6%; weekly MID of 28.6 (95% confidence interval [CI] 13.3 to 44.0; p = 0.001). The occurrence of all ACS types was reduced: STEMI, by 28.1%; weekly MID 7.3 [0.6-15.2]; p = 0.048]; NSTEACS by 50.5%, weekly MID 19.1 [13.9-24.4]; p < 0.001]. Invasive procedures were also reduced: coronary angiography by 42.5%, weekly MID 26.6 [13.4-39.2]; p = 0.001]; percutaneous coronary intervention (PCI) by 42.3%, weekly MID 16.1 [5.9-26.3], p = 0.004]. Compared to 2019, during the COVID-19 period, there was a 2.4 fold increase in the inhospital death (3% vs 7.2%) with a significant weekly MID 1.4 [0.2-2.7) P=0.032]. A 2.6-fold increase in the occurrence of cardiogenic shock was also observed (13.1% vs. 5.1%, p < 0.0001). CONCLUSIONS: The admissions for ACS and invasive revascularization procedures were significantly reduced, whereas the death rate was increased during COVID 19 pandemic outbreak in Albania compared with the same period in 2019.