Acute Coronary Syndromes in the Era of SARS-CoV-2 Infection: A Registry of the French Group of Acute Cardiac Care

Koutsoukis, Athanasios; Delmas, Clément; Roubille, François; Bonello, Laurent; Schurtz, Guillaume; Manzo-Silberman, Stéphane; Puymirat, Etienne; Elbaz, Meyer; Bouisset, Frédéric; Meunier, Pierre-Alain; Huet, Fabien; Paganelli, Franck; Laine, Marc; Lemesle, Gilles; Lamblin, Nicolas; Henry, Patrick; Tea, Victoria; Gallet, Romain; Teiger, Emmanuel; Huguet, Raphaëlle; Fard, Damien; Lim, Pascal

BACKGROUND: We aimed to report clinical characteristics and outcomes of patients with and without SARS-CoV-2 infection referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. METHODS: We included all consecutive patients referred for ST-elevation myocardial infarction (STEMI) or NSTEMI during the first 3 weeks of April 2020 in 5 university hospitals (Paris, south and north of France), all performing primary percutaneous coronary intervention (PCI). RESULTS: The study included 237 patients (67±14, 69% of male), 116 (49%) with STEMI and 121 (51%) with NSTEMI. The prevalence of SARS-CoV-2 associated ACS was 11% (n=26) and 11 patients had severe hypoxemia on presentation (mechanical ventilation or nasal oxygen >6L/min). Patients were comparable regarding medical history and risk factors, except a higher prevalence of diabetes mellitus in SARS-CoV-2 patients (53.8% vs 25.6%, p=0.003). In SARS-CoV-2 patients, cardiac arrest on admission was more frequent (26.9% vs. 6.6%, p<0.001). The presence of significant coronary artery disease and culprit artery occlusion in SARS-CoV-2 patients, was 92% and 69.4% for STEMI, 50% and 15.5% for NSTEMI. PCI was performed in the same percentage of STEMI (84.6%) and NSTEMI (84.8%) cases, regardless of SARS-CoV-2 infection, but no-reflow (19.2% vs. 3.3%, p<0.001) was greater in SARS-CoV-2 patients. In-hospital death occurred in 7 SARS-CoV-2 patients (5 from cardiac cause) and was higher compared to non-infected patients (26.9% vs 6.2%, p<0.001) CONCLUSIONS: In this registry, ACS in SARS-CoV-2 patients presented with high percentage of cardiac arrest on admission, high incidence of no-reflow and high in-hospital mortality.