Abstract
Background
Since the beginning of the COVID-19 pandemic in 2019, several countries have reported a substantial drop in the number of patients admitted with non-ST segment myocardial infarction (NSTEMI). We aimed to evaluate the changes in admissions, in-hospital management and outcomes of patients with NSTEMI in the COVID-19 era in a nationwide survey.
Methods
A prospective, multicenter, observational, nationwide study involving 13 medical centers across Israel aimed to evaluate consecutive patients with NSTEMI admitted to intensive cardiac care units (ICCUs) over an 8-week period during the COVID-19 outbreak and to compare them with NSTEMI patients admitted at the same period 2 years earlier (control period).
Results
There were 624 (43%) NSTEMI patients, of them 349 (56%) hospitalized during the COVID-19 era and 275 (44%) during the control period. There were no significant differences in age, gender and other baseline characteristics between the two study periods. During the COVID-19 era, more patients arrived at the hospital via an emergency medical system (EMS) compared with the control period (p = 0.05). Time from symptom onset to hospital admission was longer in the COVID-19 era as compared with the control period [11.5 hours (IQR2.5-46.7) vs. 2.9 hours (IQR 1.7-6.8), respectively, p-value <0.001]. Nevertheless, time from hospital admission to reperfusion was similar in both groups. Rate of coronary angiography was also similar in both groups. In-hospital mortality rate was similar in both the COVID-19 era and the control period groups (2.3% vs. 4.7%, respectively, p=0.149) as was the 30-day mortality rate (3.7% vs. 5.1%, respectively, p=0.238).
Conclusions
In contrast to previous reports, admission rates of NSTEMI were similar in this nationwide survey during the COVID-19 era. With longer time from symptoms to admission, but with the same time from hospital admission to reperfusion therapy and with similar in-hospital and 30-day mortality rates. Even in times of crisis, adherence of medical systems to clinical practice guidelines, ensures the preservation of good clinical outcomes.