Acute Coronary Syndrome Admissions Research Articles

Short-term DAPT after coronary stenting has similar ischemic and bleeding outcomes as long-term DAPT: a 5-year population-based cohort study.

Optimal duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) remains controversial. We investigated the relationship between DAPT duration following PCI and long-term ischemic and bleeding outcomes under real-world conditions. Patients aged ≥ 65years who underwent PCI with stenting in Western Australian hospitals between 2003 and 2008 and survived 2years were identified from linked hospital admissions data. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE) defined as a composite of all-cause death and admissions for acute coronary syndrome (ACS), coronary artery revascularization procedure, stroke, and major bleeding. Secondary outcomes were ACS admissions, all-cause death, and major bleeding admissions. Patients were followed up for 5years from initial PCI. A total of 3963 patients were included in the final analysis. The mean age of the cohort was 74.5 ± 6.1years with 67.3% males. No significant difference was seen with 6-12, 12-18, or 18-24months DAPT, compared to 0-6months DAPT duration for MACCE and all secondary outcomes at 3- and 5-year post-PCI. There is no significant difference in both bleeding and ischemic outcomes in long-term DAPT as compared to short-term DAPT for first- and second-generation drug-eluting stents in a real-world population.

Decline of Admission for Acute Coronary Syndromes and Acute Cardiovascular Conditions during COVID-19 Pandemic in Veneto Region.

Background: The present study aimed to examine longitudinal trends in hospitalizations for acute coronary syndrome (ACS) before and during the COVID-19 pandemic, by reviewing the data from 13 hospitals of the Veneto Region, in the north-east of Italy. Methods: We performed a multicenter, retrospective analysis including all the consecutive patients presenting with ACS and other acute cardiovascular (CV) conditions (defined as heart failure, arrhythmias, cardiac arrest and venous thromboembolism) hospitalized in 13 different hospitals of the Veneto Region covering a population of 2,554,818 inhabitants, during the first (between 15 March 2020 and 30 April 2020) and second (between 15 November 2020 and 30 December 2020) COVID-19 pandemic waves (the 2020 cohort). Data were compared with those obtained at the same time-windows of years 2018 and 2019 (the historical cohorts). Results: Compared to the historical cohorts, a significant decrease in the number of ACS cases was observed in 2020 (−27.3%, p = 0.01 and −32%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). The proportion of patients hospitalized for acute CV conditions decreased during the first and second wave COVID-19 pandemic when compared to the historical cohorts (−36.5%, p < 0.001 and −40.6%, p < 0.001, comparing 2018 versus 2020 and 2019 and 2020, respectively). Pearson’s correlation evidenced a significant inverse relationship between the number of COVID-19 cases and both ACS hospital admissions (r = −0.881, p = 0.005) and hospitalizations for acute CV conditions (r = −0.738, p = 0.01), respectively. Conclusions: The decrease in hospitalizations for ACS and other acute CV conditions will strongly affect future patients’ management since undiagnosed nonfatal CV events represent a source of increased (and unknown) CV morbidity and mortality.

Estimating the economic impact of acute coronary syndrome in New Zealand over time (ANZACS-QI 64): a national registry-based cost burden study

ObjectivesTo estimate the changes in costs associated with acute coronary syndrome (ACS) admissions in New Zealand (NZ) public hospitals over a 12-year period.DesignA cost-burden study of ACS in NZ was...

Pattern of Admission, Management and In hospital Outcome of ACS Patients during COVID-19 pandemic - A study in Tertiary Care hospital

Aim: This study aimed to evaluate the impact of coronavirus disease2019(Covid-19) outbreak on admissions for acute coronary syndrome (ACS) and related mortality, severity of presentation, major cardiac complications, and outcome in tertiary care hospital (NICVD). Method: This is a cross sectional observational study on ACS admitted patients during the 1st and 2nd phase of COVID-19 from 1st June to 31st August in the year 2020 and 2021 who were COVID negative (RT PCR). Using a control of ACS admitted patients during corresponding period of year 2019 from registry. Results: During the 1st phase of COVID (July to August 2020) 736 ACS patients were enrolled where as during 2nd phase (July to August 2021) 722 ACS patients were enrolled. Mean age were 52±8 vs 53±11 years. Demographic variables such as age, sex and risk factors are almost identical in all groups. Our study showed 46% decline in admission in ACS patients comparing same period of 2019. Though some inclination in 2021 still it showed 13% decline in ACS patient admission in comparison to 2019. There was substantial increase in percentage of patient suffering from STEMI in 2020(42% vs66% vs46%). Short time in hospital complications were more pronounced in 2020. During the study period average death rate was higher than the year 2019 (8.6% vs 5.8%). There was significant decline in numbers of interventions(CAG and PCI) for CAD during first phase of Covid which raised during second phase(429 vs 2151). Total number of interventions done of 1884 patients in 2019 whereas 2151 patients were undergone in the year 2021. Conclusion: The Covid-19 outbreak affects hospital admission for acute coronary syndrome. During the first phase of the pandemic, significantly less patients with ACS admitted, but those admitted presented with a higher mortality, more complications and a worse short time outcome. Therefore ,our data indicate that Covid- 19 had relevant impact on non-infectious disease status, such as acute coronary syndrome. Bangladesh Heart Journal 2022; 37(1): 65-71

Prognostic value of exercise stress echocardiography in patients with known coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Exercise stress echocardiography (EE) is useful for diagnosis and risk stratification in patients (pts) with suspected coronary artery disease (CAD). Pts with known CAD carry a high risk of events. Our aim was to assess the utility of EE in predicting outcomes in this population. Methods Single center retrospective study of consecutive pts with known CAD who performed an EE between 2018 and 2019. The primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up. Results A total of 76 pts were included (mean age 59±9 years; 87% male). Fifty-nine (78%) pts had history of ACS, 51 (67%) of percutaneous coronary intervention (PCI) and 14 (18%) of coronary artery bypass graft. The majority of pts had 2 or more vessel disease (42 pts; 55%). The main reason for performing EE was new onset of chest pain (38 pts; 50%) followed by functional assessment of coronary stenoses after incomplete revascularization (29 pts; 38%). The majority of pts had a preserved left ventricular ejection fraction (67; 88%). The exam was performed under beta-blocker effect in 35 (46%) pts. The results of EE were positive for myocardial ischemia in 7 (9%) pts, negative in 37 (49%) pts and inconclusive in 32 (42%) pts. Mean exercise time was 8±3 minutes and mean METs achieved was 9.4±2.6. ST-segment depression fulfilling electrocardiographic criteria for ischemia occurred in 17 (22%) pts. Eleven (14%) pts complained of chest pain during the exam. During a median follow up of 22 months (IQR 15-26), the primary endpoint occurred in 9 pts (admission for ACS in 5 pts; revascularization for chronic coronary syndrome in 4 pts). No cardiovascular death occurred. The positive predictive value of EE for the primary endpoint was 57.1% and the negative predictive value (NPV) 97.3%. In a survival analysis, the predictors of the primary endpoint were lower exercise time, lower METs achieved, untreated significant coronary lesions and a positive EE (figure). After adjustment in a multivariate analysis, a positive EE was an independent predictor of the primary endpoint (HR 4.6, 95%CI: 1.1-16.7, p=.044). Conclusion In pts with known CAD, EE had a high NPV and a positive result was an independent predictor of future cardiovascular events.

Acute coronary syndromes hospitalizations and in-hospital outcomes during and after the lockdown of corona virus disease 19 (COVID-19) pandemic outbreak

Funding AcknowledgementsType of funding sources: None.BackgroundMultiple studies documented an important reduction of acute coronary syndromes (ACS) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding the ACS admissions and outcomes during the ongoing pandemic after the initial lockdown.PurposeWe aimed to study the ACS admissions and in-hospital outcomes during and after the COVID-19 lockdown period.MethodsA retrograde single-center study was conducted. The data for all admissions were collected from March 9th, (first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for three consecutive years from 2019 to 2021. The control period was considered the year 2019 and the study periods were in 2020 (lockdown) and 2021 (ongoing pandemic). ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR [95%CI]) was used to compare all-ACS and subgroups admissions, and risk ratio (RR [95%CI]) to compare the mortality between each study period with the control one.ResultsWere included 550 ACS patients (pts) during 2019, 321 pts during 2020, and 473 pts during 2021 period. The overall-ACS admissions IRR was significantly lower during 2020 lockdown (0.58 [0.44-0.76]), and not significant during 2021 ongoing pandemic (0.86 [0.62-1.18]). During 2020 lockdown, significant reduction for STEMI and UA, the IRR respectively (0.72 [0.56-0.94]) and (0.42 [0.22-0.76]), and not significant during 2021 respectively (0.87 [0.63-1.21]) and (0.86 [0.51-1.46]) were observed. The reduction in NSTEMI admissions was not significant in both periods.The overall mortality was, importantly increased during the lockdown period (7.45 vs. 3.4 %), RR=2.16 (1.2-3.89). Meanwhile the 2021 mortality was similar (4.2 vs. 3.4%), RR=1.22 (0.66-2.26).ConclusionsAfter the initial reduction of admissions in all-ACS, STEMI and UA during the 2020 lockdown period and the increase of all-ACS mortality, the number of admissions and the mortality returned to a similar range during 2021 despite the ongoing COVID-19 pandemic.

Reduction in Hospital Admissions for Cardiovascular Diseases (CVDs) during the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Study from a Southern Italian Region in the Year 2020.

(1) Background: The COVID-19 pandemic has indirect consequences for healthcare for other diseases, known as collateral damage. This situation heavily affects healthcare systems, causing changes in patterns of hospital admission. During the peak of the coronavirus disease 2019 pandemic, numerous studies reported a reduction in admissions for acute coronary syndrome. The aim of this study was to evaluate the incidence of admissions for cardiovascular diseases in Abruzzo, a region of Southern Italy, in the year 2020 and compare it to the two previous years (2018–2019). (2) Methods: This retrospective study was conducted in Abruzzo, Italy. The monthly number of admissions in the year 2020 was compared to a control period made from the average number of events that occurred in the previous two years (2018–2019). (3) Results: A global reduction in hospital admissions for all the cardiovascular diseases (CVDs) considered was observed. In particular, compared to the control period, in 2020, the number of admissions for ST-segment elevation myocardial infarction (STEMI) was lower by 34 (hospitalization rate ratio, HRR, 0.93; p < 0.001), the number of non-ST-segment-elevation myocardial infarctions (N-STEMI) was lower by 154.5 (HRR 0.89; p < 0.001), the number for acute coronary syndrome (ACS) was 340 lower (HRR 0.90; p < 0.001) and the number for heart failure (HF) was 1424.5 lower than during the control period (HRR 0.73; p < 0.001). (4) Conclusions: The results of this study show the impact of COVID-19 on admissions for CVDs, suggesting the need for strategic measures to overcome the burden of hospitalizations in future years.

Impact of coronavirus disease 19 (COVID-19) pandemic on gender differences of acute coronary syndromes admissions and in-hospital outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results. Purpose The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes. Methods A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality. Results There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27). Conclusions Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.

Dynamics of Emergency Cardiovascular Hospital Admissions and In-Hospital Mortality During the COVID-19 Pandemic: Time Series Analysis and Impact of Socioeconomic Factors.

AimsThis study aimed to evaluate the decline in urgent cardiovascular hospital admissions and in-hospital mortality during the COVID pandemic in two successive waves, and to evaluate differences by sex, age, and deprivation index subgroups.Methods and ResultsWe obtained acute cardiovascular hospital episodes during the years 2019–2020 from region-wide data on public healthcare usage for the population of Catalonia (North-East Spain). We fitted time models to estimate the incidence rate ratios (IRRs) of the acute coronary syndrome (ACS) and acute heart failure (HF) admissions during the first pandemic wave, the between-waves period, and the second wave compared with the corresponding pre-COVID-19 periods and to test for the interaction with sex, age, and area-based socioeconomic level. We evaluated the effect of COVID-19 period on in-hospital mortality. ACS (n = 8,636) and HF (n = 27,566) episodes were defined using primary diagnostic ICD-10 codes. ACS and HF admissions decreased during the first wave (IRR = 0.66, 95%CI: 0.58–0.76 and IRR = 0.61, 95% CI: 0.55–0.68, respectively) and during the second wave (IRR = 0.80, 95%CI: 0.72–0.88 and IRR = 0.76, 95%CI: 0.69–0.84, respectively); acute HF admissions also decreased in the period between waves (IRR: 0.81, 95%CI: 0.74–0.89). The impact was similar in all sex and socioeconomic subgroups and was higher in older patients with ACS. In-hospital mortality was higher than expected only during the first wave.ConclusionDuring the first wave of the COVID-19 pandemic, there was a marked decline in urgent cardiovascular hospital admissions that were attenuated during the second wave. Both the decline and the attenuation of the effect have been similar in all subgroups regardless of age, sex, or socioeconomic status. In-hospital mortality for ACS and HF episodes increased during the first wave, but not during the second wave.

Impact of COVID-19 on Acute Myocardial Infarction Care.

The global health crisis caused by the COVID-19 pandemic has evolved rapidly to overburden health care organizations around the world and has resulted in significant morbidity and mortality. Many countries have reported a substantial and rapid reduction in hospital admissions for acute coronary syndromes and percutaneous coronary intervention. The reasons for such abrupt changes in health care delivery are multifactorial and include lockdowns, reduction in outpatient services, reluctance to seek medical attention for fear of contracting the virus, and restrictive visitation policies adopted during the pandemic. This review discusses the impact of COVID-19 on important aspects of acute MI care.

Same-day air pollution and ABCDE stress echo results: nitrogen dioxide increases vulnerability to pulmonary congestion

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf StressEcho 2030 study group Background Air pollution affects same-day hospital admissions for acute coronary syndromes, decompensated heart failure and arrhythmias. The present study hypothesis is that air pollution also may affect results of comprehensive cardiac functional testing unmasking a pre-clinical vulnerability. Aim To assess the effects of air pollution on stress echocardiography (SE) performed with ABCDE protocol Methods We enrolled 1292 patients with chronic coronary syndromes referred for clinically-driven dipyridamole ABCDE-SE (score results from 0= all parameters normal, to 5, all abnormal). Same day values of 5 pollutants were obtained on the same morning of testing (average of 4 hours) from publicly available data sets of regional authority of environmental protection. Air pollution score (APS) of 5 items included fine (PM 2.5) and &amp;lt;10 µm diameter particulate matter, ozone (O3), sulfur dioxide and nitrogen dioxide (NO2). According to predetermined, internationally established thresholds, APS ranged from 0 (all parameters normal or near normal, index value ≤3 in the 1 to 10 scale of UK government air quality index 2014) to 5 (all parameters abnormal). Results There was no significant correlation (r=-0.032, p = 0.276) between SE score (0.82 ± 1.08) and APS (1.96 ± 1.09). When individual pollutants were evaluated with individual items (from A to E) of SE score, NO2 concentration was correlated with rest (r=.089; p = 0.001) and peak stress B-lines in step B (r=.099; p &amp;lt; 0.001). Patients with abnormal (&amp;gt; 2) B-lines at peak stress (n = 247) were compared with those with normal (≤ 1) response (n= 1, 045). B-liners showed higher values of same-day NO2 (median value 23.1 [I.Q. range 16.2-31.0] vs 19.7 [12.5-27.4] µg/m3, p&amp;lt; 0.001) and PM 2.5 (22.0 [9.1-23.5] vs 17.6 [8.6-22.2] µg/m3, p&amp;lt; 0.001), with lower values of O3, a secondary pollutant destroyed by NO2 (44.9 [26.7-59.5] vs 48.4 [28.5-67.4] µg/m3, p= 0.040). At multivariable logistic regression analysis (Figure), NO2 predicted stress B-lines with age, hypertension, diabetes, and reduced (&amp;lt; 50%) ejection fraction. Conclusion Air pollution may modulate cardiac functional testing results. Higher concentration of NO2 and PM 2.5 are associated with more frequent pulmonary congestion mirrored by B-lines at rest and during stress. The increased inflammatory stress mediated by NO2 and PM 2.5 may increase the permeability of the alveolar capillary barrier to any given rise in pulmonary wedge pressure. Abstract table

Impact of an inconclusive exercise stress echocardiogram on cardiovascular outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Exercise stress echocardiography (ESE) is used for the assessment of suspected or known coronary artery disease (CAD); however, a certain percentage of ESE studies are inconclusive. We aim to evaluate the prognostic impact of an inconclusive ESE on cardiovascular outcomes. Methods Single-center retrospective study of consecutive patients (pts) who performed an ESE between 2018 and 2019 for diagnosis or stratification of CAD. All pts performed a symptom-limited Bruce protocol. ESE was considered inconclusive when 85% of age-predicted maximum HR was not reached. Primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up. Results A total of 141 pts were included (76% male; mean age 60 ± 9 years). ESE was inconclusive in 51 (36%) pts, positive in 11 (8%) and negative in 79 (56%). The mean exercise time of pts with inconclusive ESE was 7 ± 2 minutes and 76% had normal functional capacity. Fatigue (25 pts; 49%) and lower extremities pain (11 pts; 22%) were the main reasons for ESE stopping. Five pts (10%) complained of chest pain during exam. Pts with an inconclusive ESE were more diabetic (inconclusive 43%, positive 9%, negative 13%; p=.001), had more chronic obstructive pulmonary disease (COPD) (14%, 0%, 2.5%; p=.026), performed more frequently the exam under beta blocker (BB) therapy (59%, 27%, 18%; p=.041) and had less ST-segment depression fulfilling electrocardiographic criteria for ischemia (10%, 64%, 27%, p&amp;lt;.001). Their functional capacity was worse than negative ESE pts (p&amp;lt;.001). During a median follow up of 22 months (IQR 15-27), 13 (9.2%) pts had the primary endpoint, including 5 pts (3.5%) with ACS. Pts with an inconclusive ESE had a lower incidence of the primary outcome than pts with a positive ESE and a higher incidence of events than pts with negative results (figure). In multivariate analysis, after adjusting for functional capacity and electrocardiographic criteria for ischemia, an inconclusive ESE was an independent predictor of the primary endpoint (HR 9.7, IC95% 1.1-87,6 p= .042) Conclusions The frequency of inconclusive ESE is not negligible (36%). These pts had more diabetes and COPD and performed the exam under BB therapy more frequently, highlighting the importance of proper patient selection. An inconclusive ESE was associated to a higher risk of cardiovascular events compared to negative ESE. Abstract Figure.

Clinical manifestation and impact on management of acute coronary syndrome during covid-19 pandemic, lessons learnt from a tertiary care

Funding AcknowledgementsType of funding sources: None.IntroductionThe World Health Organization first characterized COVID-19 as a ongoing pandemic since 12th March 2020. Since then, mitigation plans including vaccinations are on the run globally. During this pandemic several restrictions worldwide are being followed , which had major impact on acute coronary syndrome presentation due to various factors.At our tertiary cardiac care centre we analyzed the consecutive acute coronary syndrome admissions and its impact in the management during the pandemic lockdown .PurposeOur study aimed in identifying the salient clinical manifestations and impact on the management of Acute Coronary Syndrome (ACS) during the 1st wave of COVID-19 Pandemic in a tertiary care center to inform future implications/preparedness for ACS care during the revolving Pandemic.MethodsClinical profile of patients admitted in our tertiary coronary care unit between March – June 2020 was analyzed. Descriptive statistics was performed, and continuous data were reported as mean ± SD and as percentages.ResultsAmong the consecutive 265 patients who were treated in our coronary care unit, mean age of the patients was 58.43 ± 11.366 years and about 81% of them were males. Nearly one third of the patients presented with non-ST elevation MI at the time of diagnosis. Previous history of MI was well pronounced in 63% (N = 169) of the patients with a combined history of hypertension, diabetes, dyslipidemia. A higher proportion of patients presented with mild to moderate left ventricular dysfunction (N = 123, 46.6%). Higher rates of patients needed thrombolysis care (68%) where thrombolysis with ELAXIM (N = 41), STK (N = 22) were commonly used in the process. About 96.2% of the patients presented with delayed window period of >48 hours and about 75% of them underwent ADHOC PCI procedure as the next level of management during admission. Coronary angiogram findings were suggestive of a triple vessel disease in 36% of the patients with previous history of coronary interventions with in the last 5 years. Complications of cardiogenic shock requiring IABP(N = 5). and death were very minimal and were seen in patients with previous coronary bypass surgery with in last 5 years (died, N = 2), acute pulmonary thromboembolism (IABP, N = 2) .ConclusionWe observed patients with late presentation to hospital, covid protocol has increased thrombolysis compared to primary PCI in non covid time with no major bleeding risks in our patients .Most of our patients opted for ADHOC PCI , preexisting coronary artery disease patients presented as triple vessel disease .Though late presentation no significant complication rate noted.Further study would facilitate healthcare planning and preparedness for further COVID waves.

Did media reports contribute to the reduced acute coronary syndrome admission rates during the COVID-19 pandemic?

Did media reports contribute to the reduced acute coronary syndrome admission rates during the COVID-19 pandemic?

Response to the Letter by Mr Adam Ioannou entitled 'Did media reports contribute to the reduced acute coronary syndrome admission rates during the COVID-19 pandemic?'

Response to the Letter by Mr Adam Ioannou entitled 'Did media reports contribute to the reduced acute coronary syndrome admission rates during the COVID-19 pandemic?'

Impact of Coronavirus-19 Pandemic and Lockdown on Admissions for Ischemic Heart Disease.

In early 2020, the SARS-CoV-2 pandemic caused an unprecedented overload for the health service. A decrease in admissions for Acute Coronary Syndrome (ACS) was reported during lockdown, although many aspects remain to be clarified. The main objective of this study was to evaluate the impact of the pandemic and of lockdown itself in this area. We performed a retrospective observational study based on data from patients who visited the emergency department of a tertiary hospital with chest pain during 2018-2020, as well as those who were admitted for ACS. Personal details, date of admission, additional test results (laboratory and echocardiography), and therapy were recorded. Patients were divided into 3 groups: preCOVID (n=1,301), lockdown (n=45), and postlockdown (n=343). Fewer visits to the emergency department for chest pain and admissions for ACS were recorded during lockdown (48.6% and 51.1% respectively, p<0.05). Patients who were admitted during lockdown were characterized by poorer control of cardiovascular risk factors, visited later (more evolving infarctions: 2.7% vs. 14.3%, p<0.05), experienced more echocardiographic complications during admission, and had more than 3-fold mortality rates (both in-hospital and postdischarge). The COVID-19 pandemic and lockdown itself had a negative effect on ischemic heart disease beyond SARS-CoV-2 infection.

A Team Based Approach to Follow-Up in Patients Following an Acute Coronary Syndrome Admission is as Safe and Effective as Standard Medical Only Care

A Team Based Approach to Follow-Up in Patients Following an Acute Coronary Syndrome Admission is as Safe and Effective as Standard Medical Only Care

Predictors of Time to Cardiac Surgery and Pre-Procedural Complications Post Acute Coronary Syndrome Admission: A Single Centre Experience

Patients admitted with acute coronary syndrome (ACS) often wait for coronary artery bypass surgery (CABG). The ability to predict which inpatients can safely have CABG delayed has important financial ramifications.

Anemia in patients with acute coronary syndrome: Epidemiological profile and impact on the prognosis

Anemia is an independent risk factor in coronary patients. We aimed to determine the relationship between hemoglobin levels and the evolution of patients admitted into the cardiology depart of Mongi Slim Hospital for acute coronary syndrome. This is a retrospective study of 300 patients hospitalized for acute coronary syndrome (122 patients with persistent ST segment elevation and 178 without ST elevation). The patients were subdivided into 2 groups: group A (30 anemic patients) with a hemoglobin level < 11 g/dl and group B (270 patients) with a hemoglobin level > 11 g/dl. Among the 300 patients, 256 were men (85%) and 44 were women (15%). The mean age was 59.5 ± 13.5 years. The anemic subjects were older than the non-anemic: 63 ± 9.9 years versus 57 ± 11 years. The renal function was more impaired in anemic patients with a clearance of creatinine to 54.66 ml per minute versus 93.62 ml per minute in non-anemic patients. Anemic patients had more frequently signs of left ventricular heart failure (46% versus 10%). Systolic left ventricular function, however, seemed unaffected by this rate with an ejection fraction measured at 55% in both anemic and non-anemic patients. Diastolic function was more often impaired with higher left ventricular filling pressures in anemic patients (66% versus 30%). The mean length of stay was longer for patients with anemia (12.5 ± 10.1 days versus 7.9 ± 4 days). The re-hospitalization rate was also higher in these patients. Anemia at admission for acute coronary syndrome is linked to a pejorative risk. A fairly strong relationship is found between low values of hemoglobin and the evolution of patients especially in terms of clinical or latent heart failure.

Impact of COVID-19 Pandemic on Hospital Admissions of Acute Coronary Syndrome: A Beijing Inpatient Database Study

SummaryBackgroundConsequences of reduced acute coronary syndrome (ACS) admissions during COVID-19 pandemic periods were reported by different countries. However, admissions, treatments, and prognosis of ACS during and after COVID-19 pandemic in Beijing, China was unknown.MethodsInformation on ACS admissions and heart failure (HF) admission were identified from database of Beijing Municipal Health Commission Information Center. Study period was defined as December 1, 2019 to June 30, 2020, and control period was defined as December 1, 2018 to June 30, 2019. Numbers of admission for HF during the control period, the study period, and seven months after study period were compared to evaluate the consequence of changed ACS care during the COVID-19 pandemic.FindingsAdmissions for ST-elevation myocardial infarction (STEMI), Non-ST-elevation myocardial infarction (Non-STEMI), and unstable angina (UAP) reduced by 38·0%, 41·0%, and 63·3% (N = 1953, 1991, 7664 between January 24, 2020 to June 30, 2020 vs. N = 3150, 3373, and 20,868 between January 24, 2019 to June 30, 2019) in study period. Percutaneous coronary intervention performed within 24 h were significantly more frequent during study period in patients with STEMI (37·9% vs. 31·7%, P<0·0001), but significantly less frequent in patients with Non-STEMI (7·9% vs. 9·5%, P = 0·049), and in patients with UAP (1·7% vs. 3·5%, P<0·0001). In-hospital mortality rates in patients with ACS were similar during the study period and the control period (3·1% vs 2·5%, P = 0·174 for STEMI; 2·7% vs 2·3%, P = 0·429 for Non-STEMI; 0·2% vs 0·1%, P = 0·222 for UAP). A fall by 23.9% for HF admissions was also observed during the seven months following the study period than equivalent period in 2019.InterpretationDuring COVID-19 pandemic, ACS admissions reduced significantly in Beijing; however, increase of HF admissions was not observed within seven months post-pandemic period, implying the pandemic didn't deteriorate the short-term prognosis for ACS.Fundingthe National Natural Science Foundation of China (82,103,904), the National Key Research and Development Program of China (Grant number: 2020YFC2004803).