Health care quality and changes in the clinical characteristics of patients with non-ST elevation acute coronary syndrome in a regional vascular center during the COVID-19 pandemic

Aim. To perform a comparative assessment of the clinical and demographic characteristics of patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and health care quality during the coronavirus disease 2019 (COVID-19) pandemic.

Material and methods. Data obtained from medical records were used. Statistical processing was performed using the Statistica 10.0 software package. The analysis included patients with NSTE-ACS treated in 2020 (n=524) and 2019 (n=395). The group for further analysis consisted of patients with non-ST elevation myocardial infarction treated in 2020 (n=233) compared to 2019 (n=221).

Results. An increase in the relative number of patients with unstable angina in the NSTE-ACS group was revealed. COVID-19 was verified in 5,5% of patients with NSTE-ACS. Of these, pneumonia was diagnosed in 10 (34,5%) patients, while 11 (37,9%) patients were transferred to pulmonary hospitals. The remaining 18 (62,1%) patients were discharged for outpatient treatment. Infected patients had a higher risk of in-hospital mortality according to the Global Registry of Acute Coronary Events (GRACE) score relative to general cohort of patients — 2,0 (1,0; 9,0) vs 1,0 (0,8; 3,0) (p=0,04). In addition, 215 (92,3%) patients underwent invasive coronary angiography, which is higher than in 2019 (78,7%) (p<0,001). An increase in revascularization prevalence in patients ≥75 years old was found (p=0,01).

Conclusion. COVID-19 pandemic has led to a change in the clinical characteristics of patients, while not having a significant impact on the scope of endovascular interventions and health care quality for patients with NSTE-ACS in the emergency cardiology department.

1. National project “Healthcare”. https://minzdrav.gov.ru/poleznyeresursy/natsproektzdravoohranenie. (In Russ.)

2. OECD and European Union. Health at a Glance: Europe 2018: State of Health in the EU Cycle. Paris/European Union, Brussels: OECD Publishing, 2018. p. 216. doi:10.1787/health_glance_eur2018-en.

3. Puymirat E, Simon T, Cayla G, et al. Acute Myocardial Infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI program (French Registry of Acute ST-Elevation or Non-STElevation Myocardial Infarction) 1995 to 2015. Circulation. 2017;136(20):1908-19. doi:10.1161/CIRCULATIONAHA.117.030798.

4. Chung SC, Gedeborg R, Nicholas O, et al. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet. 2014;383(9925):1305-12. doi:10.1016/S0140-6736(13)62070-X.

5. Khera S, Kolte D, Aronow WS, et al. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc. 2014;3(4):e000995. doi:10.1161/JAHA.114.000995.

6. Szummer K, Wallentin L, Lindhagen L, et al. Relations between implementation of new treatments and improved outcomes in patients with non-ST-elevation myocardial infarction during the last 20 years: experiences from SWEDEHEART registry 1995 to 2014. Eur Heart J. 2018;39(42):3766-76. doi:10.1093/eurheartj/ehy554.

7. Federal State Statistic Service. (In Russ.) https://rosstat.gov.ru.

8. Official information about the COVID-19 in Russia. (In Russ.) https://стопкоронавирус.рф.

9. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42. doi:10.1001/jama.2020.2648.

10. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. doi:10.1016/j.ijid.2020.03.017.

11. Zheng Y-Y, Ma Y-T, Zhang J-Y, et al. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-60. doi:10.1038/s41569-020-0360-5.

12. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.

13. Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):819-24. doi:10.1001/jamacardio.2020.1096.

14. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with STsegment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. doi:10.1093/eurheartj/ehx393.

15. Collet JP, Thiele H, Barbato E, et al. GCM; ESC Scientific Document Group. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289367. doi:10.1093/eurheartj/ehaa575.

16. De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med. 2020;383(1):88-9. doi:10.1056/NEJMc2009166.

17. De Rosa S, Spaccarotella C, Basso C et al., Società Italiana di Cardiologia and the CCU Academy investigators group. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41(22):2083-8. doi:10.1093/eurheartj/ehaa409.

18. Rodríguez-Leor O, Cid-Álvarez B, Ojeda S, et al. Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología intervencionista en España REC. Interv Cardiol. 2020;2:82-9. doi:10.24875/RECIC.M20000120.

19. Mafham MM, Spata E, Goldacre R, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet. 2020;396(10248):381-9. doi:10.1016/S0140-6736(20)31356-8.

20. Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in STSegment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic. J Am Coll Cardiol. 2020;75(22):2871-2. doi:10.1016/j.jacc.2020.04.011.

21. Solomon MD, McNulty EJ, Rana JS, Leong TK, Lee C, Sung SH, Ambrosy AP, Sidney S, Go AS. The Covid-19 Pandemic and the Incidence of Acute Myocardial Infarction. N Engl J Med. 2020;383(7):691-3. doi:10.1056/NEJMc2015630.

22. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20):e61851. doi:10.1161/CIR.0000000000000617.

23. Narula A, Mehran R, Weisz G, et al. Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J. 2014;35(23):1533-40. doi:10.1093/eurheartj/ehu063.

24. Ocshepkova EV, Sagaydak OV, Chazova IE. Management of acute coronary syndrome in older adults (data from russian federal acute coronary syndrome registry). Terapevticheskii arkhiv. 2018;90(3):67-71. (In Russ.) doi:10.26442/terarkh201890367-71.

25. Ryabov VV, Gombozhapova AE, Demyanov SV. Profile of a patient with non-ST segment elevation myocardial infarction in actual clinical practice. Russian Journal of Cardiology. 2021;26(2):4071. (In Russ.) doi:10.15829/15604071-2021-4071.

26. Ahrens I, Averkov O, Zúñiga EC, et al. Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risktreatment paradox. Clin Cardiol. 2019;42(10):1028-40. doi:10.1002/clc.23232.

27. Schüpke S, Neumann FJ, Menichelli M, et al. Ticagrelor or Prasugrel in patients with acute coronary syndromes. N Engl J Med. 2019;381(16):1524-34. doi:10.1056/NEJMoa1908973.