Impact of the SARS-COV-2 pandemic on acute coronary syndrome patients admitted to an urbanacademic hospital in Soweto, South Africa

Abstract

Background: Recent worldwide data has shown a concerning decline in the number of acute coronary syndrome (ACS) related admissions and percutaneous coronary intervention (PCI) procedures during the coronavirus disease 2019 (COVID-19) pandemic. We suspected a similar trend at Chris Hani Baragwanath Hospital (CHBAH). Aim: To evaluate the impact of the COVID-19 pandemic on ACS patients admitted to the cardiac care unit (CCU) in CHBAH. Methods: A retrospective descriptive study was conducted to evaluate and compare all ACS-related admissions to CCU at CHBAH in the pre-COVID-19 (November 2019 to March 2020) and during COVID-19 periods (April 2020 to August 2020). Results: The study comprised 182 patients with a mean age of 57.9 ±10.9 years (22.5% females). Of these, 108 patients were admitted in the pre-COVID 19 period. During the pre-COVID-19 period, 42.9% of patients presented with ST-segment- elevation myocardial infarction (STEMI), 39.2% with non -ST segment -elevation myocardial infarction (NSTEMI) and unstable angina (UA) was noted in 18.52%. In contrast, STEMI was noted in 50%, NSTEMI in 43.24% and UA in 6.76% of patients during the COVID-19 period. A statistically significant difference in STEMI and NSTEMI-related admissions was not noted, however there were a greater number of admissions for UA during the pre-COVID-19 period (18.52% vs 6.76%, P =0.013). Only a third of the patients with STEMI received thrombolysis during the pre- and COVID-19 periods (30.4% vs 37.8%, P=0.47). No difference in the number of PCI procedures was noted between the pre- and COVID-19 periods (78.7% vs 72.9%, P=0.37). There was a trend towards a lower left ventricular ejection fraction (48.6% vs 34.2%, P=0.05) and increased diagnosis of heart block (5.4% vs 0.9%, P=0.06) during COVID as compared to the pre-COVID-19 period. More arrhythmias (8.3%) were noted in the pre-COVID-19 period (P=0.011). Conclusion: There was no difference in ACS admissions to the CCU during pre- and COVID-19 periods. Although the assessment of the full impact of COVID-19 on ACS admissions to the hospital was limited, in the CCU, there was a higher number of UA admissions during the pre-COVID-19 period. During both periods, the use of vi thrombolysis was low for STEMI and no difference in PCI was noted. There were no differences in complications observed between the two periods, except for a higher rate of arrhythmias noted in the pre-COVID-19 period.