Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

Fabrizio D'Ascenzo, Ovidio De Filippo, Andrea Borin, Lucia Barbieri, Marianna Adamo, Nuccia Morici, Alessandra Truffa Giachet, Mario Iannaccone, Gabriele Crimi, Luca Gaido, Pier Paolo Bocchino, Carlo Andrea Pivato, Gianluca Campo, Daniela Trabattoni, Alaide Chieffo, Nicola Gaibazzi, Filippo Angelini, Andrea Rubboli, Andrea Rognoni, Giuseppe MusumeciFabrizio Ugo, Sebastiano Gili, Bernardo Cortese, Paolo Vadalà, Veronica Dusi, Guglielmo Gallone, Giuseppe Patti, Gaetano Maria de Ferrari

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods: Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results: Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion: ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusAccepted/In press - 2021

Keywords

  • Acute coronary syndromes
  • Cardiovascular outcomes
  • COVID-19

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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