The impact of the pandemic on the acute coronary syndrome profile: A retrospective comparative analysis

Background and Aim: The coronavirus outbreak of 2019 (COVID-19) was announced as a pandemic by the World Health Organization (WHO) on March 11, 2020 Similar to many other countries, a national emergency was declared in our country In order to reserve the healthcare capacity for the COVID-19 patients by preventing hospitals from overloading, the routine of healthcare systems had to be remodeled In many centers worldwide, the number of ACS patients applying to emergency services and being followed in coronary intensive care units were reported to be reduced following the COVID-19 pandemic, along with increased time before treatment and increased in-hospital mortality rate These aspects have not been thoroughly evaluated in our country so far Methods: In this retrospective study, the data of the ACS patients who applied to our clinic before (March-April 2019) and during (March-April 2020) the COVID-19 pandemic were evaluated in regards to the type of application to the clinic, symptom duration, door-to-balloon times, treatment approaches, length of hospitalization, in-hospital mortality and complication rates The data were obtained from the patient files and the hospital's database Results: The number of ACS patients that applied to our clinic, which operated as a 'COVID-free' tertiary referral center, before (n=98) and during (n=98) the pandemic was the same In these two periods, NSTEMI diagnosis was similar (n=53, 54% vs n=52, 53%), however, a decrease in the number of patients diagnosed with USAP (n=11, 11% vs n=5, 5%), and an increase in STEMI patients (n=34, 34% vs n=41, 42%) was remarkable We observed an increase in the interval between the onset of symptoms and hospital admission during the pandemic (median 88 3 hrs vs 106 5 hrs, p=0 02) In the patients treated with PCI revascularization, there was no significant change in the door-to-balloon time (median 64 min vs 76 min, p=0 96) While there was a numerical increase in the complication rate during PCI, this increase was not statistically significant (n=6, %6 1 vs n=11, %11 2, p=0,20) In-hospital mortality was %1 0 (n=1) before the pandemic, and increased to 3 1% (n=3) during the pandemic (p=0 14) Conclusions: During the COVID-19 pandemic, there was an increase in the interval between the onset of symptoms and hospital admission among ACS patients, which may either be attributed to patient or transfer issues On the other hand, door-to-balloon times were similar While there was an increase in patients with STEMI, there was a decrease in patients with USAP Unlike the observations worldwide, the total number of ACS patients remained stable during the pandemic We attributed this to the fact that our clinic operated as a 'COVID-free' tertiary referral center, and there was an increase in the number of patients referred from other clinics in this period There were no significant changes in the complication and mortality rates