scholarly journals Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study

QJM ◽  
2021 ◽  
Author(s):  
D Araiza-Garaygordobil ◽  
C Montalto ◽  
P Martinez-Amezcua ◽  
A Cabello-Lopez ◽  
R Gopar-Nieto ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Acute Coronary Syndromes ◽  
Epidemiological Data ◽  
Historical Period ◽  
Ischemic Time ◽  
Mechanical Complications ◽  
Grace Risk Score ◽  
Before And After ◽  
Coronary Syndromes ◽  
Door To Balloon

  Background: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. Conclusions: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

scholarly journals MOST PATIENTS WITH ACUTE CORONARY SYNDROMES ARE ALREADY AT HIGH RISK PRIOR TO THE EVENT AND LIPID MANAGEMENT IS UNDERACHIEVED BOTH BEFORE AND AFTER HOSPITALIZATION: THE PHAETHON STUDY

2017 ◽  
Vol 69 (11) ◽  
pp. 1808
Author(s):  
Dimitrios Terentes-Printzios ◽  
Charalambos Vlachopoulos ◽  
George Andrikopoulos ◽  
Stylianos Tzeis ◽  
Efstathios Iliodromitis ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Lipid Management ◽  
Before And After ◽  
Coronary Syndromes

scholarly journals Residual inflammatory risk at 12 months after acute coronary syndromes is associated with cardiovascular outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Klingenberg ◽  
S Aghlmandi ◽  
D Nanchen ◽  
L Raeber ◽  
B Gencer ◽  
...  
Keyword(s):  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Coronary Revascularization ◽  
Demographic Data ◽  
Cardiovascular Outcome ◽  
P Value ◽  
Funding Source ◽  
Grace Risk Score ◽  
Coronary Syndromes

Abstract Background C-reactive protein measured by high sensitivity assays (hsCRP) is an established biomarker of systemic inflammation and a cut-off at 2 mg/L has been widely studied and proposed to identify patients at residual inflammatory risk (RIR). Purpose It remains unclear how many patients remain at residual inflammatory risk (RIR) at 12 months after acute coronary syndromes (ACS) in a contemporary real-world cohort and if RIR is associated with cardiovascular outcome. Methods Patients included in the SPUM-ACS cohort (NCT01000701) with a primary diagnosis of ACS referred for coronary angiography between 2009 and 2012 and available hsCRP measurements at baseline and at 1 year follow-up. High RIR was defined as hsCRP ≥2mg/L. Patients were divided into four groups: persistently high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistently low RIR. Adjudicated major adverse cardiac and cerebrovascular events (MACCE) at 365 days were defined as the composite of MI, clinically indicated coronary revascularization or stroke. Logistic regression models were used to evaluate associations between MACCE and RIR groups and continuous long-term GRACE risk score. Adjustment was made for long-term GRACE risk score. Results 1209 patients had available serial biomarker measurements (baseline and 12 months) with clinical and demographic data. Among those, 295 (24.4%) patients (UA 3.4%, NSTEMI 47.5%, STEMI 49.2%) fell in the category persistently high RIR (delta hsCRP median (IQR): −2.3 (−9.9; 0.3) (mg/L) and 72 (5.96%) patients (UA 8.3%, NSTEMI 47.2%, STEMI 44.4%) were in category increased RIR (delta hsCRP median (IQR): +2.45 (1.2; 8.35) (mg/L). Conversely, 390 (32.26%) patients (UA 3.3%, NSTEMI 46.9%, STEMI 49.7%) fell in the category attenuated RIR (delta hsCRP median (IQR): −3.55 (−10; −2) (mg/L) and 452 (37.38%) patients (UA 5.5%, NSTEMI 33.2%, STEMI 61.3%) were in category persistently low RIR (delta hsCRP median (IQR): −0.2 (−0.6; 0.1) (mg/L). Of 90 MACCE, 31 (10.5%) were found in the persistently high RIR group yielding a significantly higher event rate (adjusted HR: 1.71, (95% CI 1.08; 2.7), p-value: 0.02) compared with the three other groups combined (increased RIR: 3 (4.2%), attenuated RIR 30 (7.7%), persistent low RIR 26 (5.8%)). Of note, in that group the long-term GRACE risk score was significantly higher compared with the three other groups (adjusted HR: 1.1, (95% CI 1.0; 1.17), p-value: 0.04). Conclusion Residual inflammatory risk at 12 months after an ACS is found in nearly a third of patients. Patients with persistently elevated hsCRP throughout the first year post-ACS suffered most adverse events warranting studies of anti-inflammatory drugs in these patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation, Swiss National Science Foundation

scholarly journals Prognostic Value of SYNTAX Score II in Patients with Acute Coronary Syndromes Referred for Invasive Management: A Subanalysis from the SPUM and COMFORTABLE AMI Cohorts

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Slayman Obeid ◽  
Antonio H. Frangieh ◽  
Lorenz Räber ◽  
Nooraldaem Yousif ◽  
Thomas Gilhofer ◽  
...  
Keyword(s):  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Prognostic Value ◽  
Syntax Score ◽  
Repeat Revascularization ◽  
Grace Risk Score ◽  
Syntax Score Ii ◽  
All Cause Mortality ◽  
Coronary Syndromes

Aims. To assess the incremental prognostic value of SYNTAX score II (SxSII) as compared to anatomical SYNTAX Score (SxS) and GRACE risk score in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Methods and results. SxSII and SxS were determined in 734 ACS patients. Patients were enrolled in the prospective Special Program University Medicine ACS and the COMFORTABLE AMI cohorts and later on stratified according to tertiles of SxSII (SxSIILow ≤21.5 (n=245), SxSIIMid 21.5–30.6 (n=245), and SxSIIHigh ≥30.6 (n=244). The primary endpoint of adjudicated all-cause mortality and secondary endpoints of MACE (cardiac death, repeat revascularization, and myocardial infarction) and MACCE (all-cause mortality, cerebrovascular events, MI, and repeat revascularization) were determined at 1-year follow-up. SxSII provided incremental predictive information for risk stratification when compared to SxS and GRACE risk score (AUC 0.804, 95% CI 0.77–0.84, p<0.001 versus 0.67, 95% CI 0.63–0.72, p=0.007 versus 0.69, 95% CI 0.6–0.8, p=0.002), respectively. In a multivariable Cox regression analysis, we found that unlike SxS (adjusted HR 1.013, 95% CI (0.96–1.07), p=0.654), SxSII was significantly associated with all-cause mortality (HR = 1.095, 95% CI (1.06–1.11), p<0.001). This was also true for the prediction of both secondary outcomes MACE (n=60) and MACCE (n=70) with an adjusted HR = 1.055, 95% CI (1.03–1.08), p<0.001, and HR = 1.065, 95% CI (1.04–1.09), p<0.001. Conclusion. In patients with ACS who underwent PCI, SxSII is an independent predictor of mortality during 1-year follow-up. SxSII shows superiority in discriminating risk compared to conventional SxS and GRACE for all-cause mortality.

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