Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry()

D'Ascenzo, Fabrizio; De Filippo, Ovidio; Borin, Andrea; Barbieri, Lucia; Adamo, Marianna; Morici, Nuccia; Truffa Giachet, Alessandra; Iannaccone, Mario; Crimi, Gabriele; Gaido, Luca; Bocchino, Pier Paolo; Pivato, Carlo Andrea; Campo, Gianluca; Trabattoni, Daniela; Chieffo, Alaide; Gaibazzi, Nicola; Angelini, Filippo; Rubboli, Andrea; Rognoni, Andrea; Musumeci, Giuseppe; Ugo, Fabrizio; Gili, Sebastiano; Cortese, Bernardo; Vadalà , Paolo; Dusi, Veronica; Gallone, Guglielmo; Patti, Giuseppe; de Ferrari, Gaetano Maria

INTRODUCTION: The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. METHODS: Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. RESULTS: Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. CONCLUSION: ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.