Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience.

Aktürk, İbrahim Faruk; Yıldız, Cennet; Karabulut, Dilay; Oflar, Ersan; Şahin, Alparslan; Ertuğrul, Abdulcelil Sait; Koyuncu, Atilla; Polat, Veli; Karahan, Aysun; Koşar, Feridun; Alp, İlayda Bostancı; Keskin, Kudret; Çağlar, Fatma Nihan Turhan

BACKGROUND In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic. METHODS A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes. RESULTS During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05). CONCLUSION Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.