The global coronavirus disease-2019 (COVID-19) pandemic is associated with reduced rate of percutaneous coronary intervention (PCI). However, there were a few data showing how emergency medical system (EMS) and management strategies for acute coronary syndrome (ACS) changed during the pandemic. We sought to clarify changes on characteristics, treatments, and in-hospital mortality of patients with ACS transported via EMS between pre- and post-pandemic. We examined consecutive 656 patients with ACS admitted to Sapporo City ACS Network Hospitals between June 2018 and November 2021. The patients were divided into pre- and post-pandemic groups. The number of ACS hospitalizations declined significantly during the pandemic (proportional reduction 66%, coefficient −0.34, 95% CI −0.50 to −0.18, p < 0.001). The median time from an EMS call to hospital was significantly longer in post-pandemic group than in pre-pandemic group (32 [26–39] vs. 29 [25–36] min, p = 0.008). There were no significant differences in the proportion of patients with ACS receiving PCI, and in-hospital mortality between the groups. The COVID-19 pandemic had a significant impact on EMS and management in patients with ACS. Although a significant decline was observed in ACS hospitalizations, the proportion of patients with ACS receiving emergency PCI remained during the pandemic.
Background: The characteristics of high-risk coronary atherosclerosis evaluated using optical coherence tomography can have a prognostic role. Inflammatory biomarkers may be related to the severity of coronary artery disease. This study investigated the association of high-risk morphological features of coronary plaques on optical coherence tomography with circulating levels of inflammatory biomarkers and adverse cardiovascular events.
Methods: We prospectively analyzed the data of 30 consecutive patients with chronic coronary syndrome who underwent percutaneous coronary intervention using optical coherence tomography between April 2020 and November 2020 at our university hospital. Estimation of inflammatory biomarker levels and optical coherence tomography analysis focused on high-risk coronary plaque features were performed. Based on the coronary plaque risk score, patients were defined as having a low coronary plaque risk score (coronary plaque risk score≤3) or high coronary plaque risk score (coronary plaque risk score≥4). The primary outcome was target lesion revascularization.
Results: Targetlesion revascularization was achieved in 6 (20%) patients within 15 months of percutaneous coronary intervention. High coronary plaque risk score on optical coherence tomography was directly correlated with target lesion revascularization (P=0.029). In logistic regression analysis, coronary plaque risk score was associated with target lesion revascularization (odds ratio, 10.0; 95% confidence interval, 1.34–74.5). Serum monocyte chemoattractant protein-1 level was significantly correlated with the coronary plaque risk score (P=0.020).
Conclusions: In patients with chronic coronary syndrome, coronary plaque risk score may be a surrogate predictor of target lesion revascularization. Serum monocyte chemoattractant protein-1 may aid detection of high-risk coronary atherosclerosis.
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