Incidence, Clinical Characteristics, Risk Factors and Outcomes of Acute Coronary Syndrome in Patients With COVID-19: Results of the UMC-19-S1010.
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Alquézar-Arbé Aitor, Miró Òscar, Castillo Juan González Del, Jiménez Sònia, Llorens Pere, Martín Alfonso, Martín-Sánchez Francisco Javier, García-Lamberechts Eric Jorge, Piñera Pascual, Jacob Javier, Porrino Juan Miguel Marín, Jiménez Blas, Río Rigoberto Del, García Carles Pérez, Aznar José Vicente Brasó, Ponce María Carmen, Fernández Elena Díaz, Tost Josep, Mojarro Enrique Martín, García Arturo Huerta, Quirós Alejandro Martín, Noceda José, Cano María José Cano, Almela Amparo Fernández de Simón, Bayarri María José Fortuny, Tejera Matilde González, Rodriguez Alberto Domínguez, Burillo-Putze Guillermo, Spanish Investigators on Emergency Situations TeAm (SIESTA) Network
Аннотация
OBJECTIVE: We investigated the incidence, clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department.
METHODS: We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes.
RESULTS: We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% [95% confidence interval {CI} 1.21-1.78%]). This incidence was lower than that observed in non-COVID-19 patients (3.64% [95% CI 3.54-3.74%]; odds ratio [OR] 0.40 [95% CI 0.33-0.49]). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR [aOR] 6.36 [95% CI 1.84-22.1], aOR 4.63 [95% CI 1.88-11.4], and aOR 2.46 [95% CI 1.15-5.25]). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4).
CONCLUSIONS: The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.