[COVID-19 pandemic : Effects on clinical care of cardiovascular patients in spring 2020]

[Clinical and procedural characteristics of patients with acute coronary syndrome during the COVID-19 pandemic 2020 compared to a control group from 2019]

BACKGROUND

During the COVID-19 pandemic medical treatments including emergencies were often delayed, in part because of fear of an infection with Sars-CoV-2. Even patients with an acute coronary syndrome (ACS) were affected by these circumstances. In the present study we provide a systematic comparison of patients with ACS during the COVID-19 pandemic compared to a control group.

METHODS

This is a retrospective cross-sectional study including all patients admitted with an ACS (STEMI, NSTEMI, unstable angina) undergoing coronary angiography between March 2019 and June 2019 (group A) and between March 2020 and June 2020 (group B). Demographic factors, cardiovascular risk factors and procedural data (extent of coronary disease, clinical diagnose, revascularisation strategy and outcome, use of mechanical support devices, door-to-needle time and in-hospital mortality) were compared.

RESULTS

469 patients were included in the present study (239 patients in group A and 230 in group B, mean age 69 years, 71% male). Compared to group A there were fewer patients with STEMI and unstable angina (p=0,033) but more patients with NSTEMI (p=0,047) in group B. Patients in group B had less often single vessel disease (p=0,001) but in contrast more often triple vessel disease compared to group A (p=0,052).

CONCLUSION

Despite overall comparable numbers of ACS patients those admitted during the COVID-19 pandemic were more frequently diagnosed with NSTEMI and had a larger extent of coronary disease compared to a control group.

Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic

Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation

Impact of SARS-CoV-2 Outbreak on Emergency Department Presentation and Prognosis of Patients with Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis

We performed an updated meta-analysis to robustly quantify admission trends of patients with ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI) during the first wave of the pandemic and to characterize on a large basis the risk profile and early prognosis. Studies having the same observation period for the comparison between SARS-CoV-2 outbreak in 2020 versus control period in 2019 were included. Primary endpoints were the relative variation of hospital admissions, the difference of in-hospital mortality for STEMI and NSTEMI. Secondary were: mortality according to countries, income levels and data quality; cardiogenic shock, mechanical complications, door-to-balloon time, time from symptom onset to first medical contact, left ventricular ejection fraction (LVEF) and troponin. In total, 61 observational studies with 125,346 patients were included. Compared with 2019, during the pandemic for STEMI were observed: a 24% reduction of hospitalizations with an impact on early survival (OR = 1.33 in-hospital mortality); the time from symptom onset to first medical contact was 91.31 min longer, whereas door-to-balloon time was increased (+5.44 min); after STEMI, the rate of cardiogenic shock was 33% higher; LVEF at discharge was decreased (−3.46); elevated high-sensitivity troponin levels (1.52) on admission. For NSTEMI, in the COVID-19 period, we observed a 31% reduction of hospitalizations and higher in-hospital deaths (OR = 1.34). The highest mortality rates among countries were: Italy OR = 3.71 (high income), Serbia OR = 2.15 (upper middle) and Pakistan OR = 1.69 (lower middle). Later hospital presentation was associated with larger infarctions, as well as with increased cardiogenic shock and in-hospital mortality.

Management of cardiogenic shock

Despite the rapidly evolving evidence base in modern cardiology, progress in the area of cardiogenic shock remains slow, with short-term mortality still reaching 40-50%, relatively unchanged in recent years. Despite advances with an increase in the number of clinical trials taking place in this admittedly difficult-to-study area, the evidence base on which we make day-to-day decisions in clinical practice remains relatively sparse. With only definitive evidence for early revascularisation and the relative ineffectiveness of intra-aortic balloon pumping, most aspects of patient management are based on expert consensus, rather than randomised controlled trials. This updated 2020 review will outline the management of CS mainly after acute myocardial infarction with major focus on state-of-the-art treatment based on randomised clinical trials or matched comparisons if available.