Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic
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Clinical features of patients with acute coronary syndrome during the COVID‑19 pandemic Kensuke Matsushita1,2 · Sebastien Hess1 · Benjamin Marchandot1 · Chisato Sato1,2 · Dinh Phi Truong1,3 · Ngoc Thanh Kim1,3 · Anne Weiss4 · Laurence Jesel1,2 · Patrick Ohlmann1 · Olivier Morel1,2 Accepted: 9 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Although a reduction in hospital admissions of acute coronary syndromes (ACS) patients has been observed globally during the coronavirus disease 2019 (COVID-19) pandemic, clinical features of those patients have not been fully investigated. The aim of the present analysis is to investigate the incidence, clinical presentation, and outcomes of patients with ACS during the COVID-19 pandemic. We performed a retrospective analysis of consecutive patients who were admitted for ACS at our institution between March 1 and April 20, 2020 and compared with the equivalent period in 2019. Admissions for acute myocardial infarction (AMI) reduced by 39.5% in 2020 compared with the equivalent period in 2019. Owing to the emergency medical services (EMS) of our region, all time components of ST-elevated myocardial infarction care were similar during the COVID-19 outbreak as compared with the previous year’s dataset. Among the 106 ACS patients in 2020, 7 patients tested positive for COVID-19. Higher incidence of type 2 myocardial infarction (29% vs. 4%, p = 0.0497) and elevated D-dimer levels (5650 μg/l [interquartile range (IQR) 1905–13,625 μg/l] vs. 400 μg/l [IQR 270–1050 μg/l], p = 0.02) were observed in COVID-19 patients. In sum, a significant reduction in admission for AMI was observed during the COVID-19 pandemic. COVID-19 patients were characterized by elevated D-dimer levels on admission, reflecting enhanced COVID-19 related thrombogenicity. The prehospital evaluation by EMS may have played an important role for the timely revascularization for STEMI patients. Keywords Coronavirus disease 2019 · Acute coronary syndrome · Percutaneous coronary intervention · Catheterization laboratory
Highlights
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02340-z) contains supplementary material, which is available to authorized users. * Olivier Morel olivier.morel@chru‑strasbourg.fr 1
• The COVID-19 outbreak was associated with a 40%
decrease in AMI.
• The delay of STEMI care was minimal in our center,
suggesting that the healthcare system effectiveness was maintained despite the pandemic. • ACS patients tested positive for COVID-19 was clearly characterized by elevated D-dimer levels on admission, reflecting enhanced COVID-19 related thrombogenicity.
Pôle d’Activité Médico‑Chirurgicale Cardio‑Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 1 place de l’Hôpital, 67091 Strasbourg cedex, France
2
UMR1260 INSERM, Nanomédecine Régénérative, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
Introduction
3
Vietnam National
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