Clinical features of patients with acute coronary syndrome during the COVID-19 pandemic

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. Electronic supplementary material The online version of this article (10.1007/s11239-020-02340-z) contains supplementary material, which is available to authorized users.

Acute Pulmonary Embolism in Patients with and without COVID-19

“…In line with previous studies reporting a decrease in the number of patients presenting to hospitals, because of emergency conditions, such as acute coronary syndrome [18][19][20], stroke [21] and APE [9], we observed a marked decline in non-COVID-19 APE between 1 March 2020 and 31 May 2020. Despite a significant increase in the use of CTPA imaging, we identified a 812% reduction in non-COVID-19 APE as compared with 2019.…”

Human Stem Cell Models of SARS-CoV-2 Infection in the Cardiovascular System

“…Potential pathways in which SARS-CoV-2 causes AMI include plaque rupture, microthrombi, and coronary spasms caused by widespread inflammation and cytokine overproduction [ 27 ]. Although there is an array of biomarkers that can be utilized for the diagnosis of ACS, ST segment elevation and increased D-dimer levels are frequently used to detect ACS in COVID-19 patients [ 23 , 63 , 64 ]. A retrospective study performed in Strasbourg, France focused on 106 ACS patients that were admitted in the hospital.…”

The Link between SARS-CoV-2 Infection, Inflammation and Hypercoagulability-Impact of Hemorheologic Alterations on Cardiovascular Mortality

“…As indicated by recent data, inflammation caused by COVID-19 may be associated with alteration of coagulation parameters, leading to an increased risk of thromboembolic complications. It seems that a direct association exists between COVID-19 and blood hypercoagulability, since elevated levels of D-dimers and fibrin degradation products, as well as prolongation of prothrombin time, have been documented in severe forms of COVID-19 and are significantly associated with increased mortality [ 1 , 7 , 8 , 9 , 10 , 11 ].…”

“…The new coronavirus not only causes respiratory disease but also affects the cardiovascular system. There is growing evidence that COVID-19 infection is associated with severe cardiovascular events, such as acute heart failure, coronary artery thrombosis or myocardial infarction [ 1 , 2 , 3 ].…”

“…Taking into consideration the strong inflammatory background of atherosclerosis, it is not surprising that cardiovascular complications, especially acute coronary syndromes, are more frequent during COVID-19 disease and a few weeks later. At the same time, COVID-19 patients frequently present an increase of D-dimers, suggesting that COVID infection is associated with increased systemic thrombogenicity [ 1 ].…”