Background
The demographics, angiographic findings, and in-hospital outcomes of coronavirus disease-2019 (COVID-19) – positive patients undergoing an invasive strategy for suspected acute coronary syndromes (ACS) are not well defined. COVID-19–positive ACS patients may have different etiology and outcomes. Patient presentation times from small sample published data appear longer.
Methods
Anonymized data on 234 patients in 81 global centers are presented from this prospective registry for the period March 1, 2020, to May 31, 2020. As of submission date, a further 84 patients have been submitted. All were required to be COVID-19–positive (or have a high index of clinical suspicion, i.e., clinical status plus chest x ray/computed tomography scan findings) and to undergo coronary angiography for suspected ACS.
Results
Results are shown in Tables 1–3 and compared with National United Kingdom British Cardiovascular Intervention Society/Myocardial Ischaemia National Audit Project databases of non–COVID-19 ACS patients where available and appropriate. Major findings were: significantly higher proportion of COVID-19–positive patients had hypertension, hyperlipidemia, and renal dysfunction. In the ST-segment elevation myocardial infarction (STEMI) subgroup, symptom-to-door time was >double and door-to-balloon increased by median 20 minutes. Mortality was quadruple and in-patient stay double in this group. Similarly, mortality was significantly higher in non-STEMI COVID-19–positive cohort and in-patient stay also double. The high mortality may be due to the high incidence of cardiogenic shock (13.4% vs. 5%), with its 67% mortality.
Conclusion
These novel data indicate that COVID-19–positive ACS patients present later, have higher incidence of cardiogenic shock, and much higher mortality, which are likely to be inter-related. In-patient stay is prolonged compared to non–COVID-19 ACS.
Categories
CORONARY: Acute Coronary Syndromes