The secondary effect of the first wave of COVID-19 and its consequences on myocardial infarction care in a high volume Hungarian cardiovascular centre

Skoda, R.; Fülöp, G.; Csulak, E.; Danics, K.; Törő, K.; Bokor, L.; Bárczi, G.; Merkely, B.; Becker, D.

Introduction: The high number of COVID-19 cases lean much burden on the healthcare system. Physicians report fewer acute coronary syndrome (ACS) patients presenting to hospitals in countries severely affected by the pandemic. It is concerning that patients with life-threatening illness can suffer more complications or die due to their myocardial infarction. We have limited information about ACS-care in countries less affected by the pandemic. Being Hungary one of them, we aimed to investigate the changes in myocardial infarction care in the country’s biggest PCI-center. Methods: A total of 512 consecutive patients have been investigated, 396 people have been treated in 2018 and 2019 compared to 116 subjects suffering ACS in 2020 during the pandemic. We compared patients’ demographical and clinical characteristics as well as out-of-hospital death rates before versus during COVID-19 outbreak. Results: A 41% (116/298) decrease in total ACS cases, a 29% (61/87) decline in STEMI and 51% (54/111) in NSTEMI patients could be witnessed during the pandemic. The proportion of STEMI patients admitted late (17.49%, 18/105 vs. 34.48%, 10/29). The number of severe cases – LM intervention, very high risk NSTEMI – decreased. Out-of-hospital mortality increased by 17%. Conclusion: Although the Hungarian healthcare system in the first wave was less burdened by the pandemic we saw a significant decline in ACS cases. The hazards of the delayed or lacking care can have a serious effect on the prognosis of these patients. Seeing the increasing number of COVID-cases in the second wave, it is even more important to raise awareness among patients and healthcare workers that ACS patients need to be treated.