Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality.
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Sticchi Alessandro, Costa Francesco, Muscoli Saverio, Zilio Filippo, Buono Andrea, Ruggiero Rossella, Scoccia Alessandra, Caracciolo Alessandro, Licordari Roberto, Cammalleri Valeria, Iacovelli Fortunato, Loffi Marco, Scordino Domenico, Ferro Jayme, Rognoni Andrea, Nava Stefano, Albani Stefano, Pavani Marco, Colaiori Iginio, Benenati Stefano, Pescetelli Fabio, DE Marzo Vincenzo, Borghesi Marco, Regazzoni Valentina, Mannarini Antonia, Spione Francesco, Doronzo Baldassarre, de Benedictis Michele, Bonmassari Roberto, Danzi Gian B, Galli Mario, Ielasi Alfonso, Musumeci Giuseppe, Tomai Fabrizio, Micari Antonio, Pasceri Vincenzo, Patti Giuseppe, Porto Italo, Campo Gianluca, Colombo Antonio, Giannini Francesco
Аннотация
METHODS: We collected sociodemographic, clinical data, procedural features, preadmission and intra-hospital outcomes of consecutive patients admitted for ACS in seventeen Italian centers from March to April 2018, 2019, and 2020.
RESULTS: In 2020, a 32.92% reduction in ACS admissions was observed compared to 2018 and 2019. Unstable angina, typical and atypical symptoms, and intermittent angina were identified as significant predictors of symptoms-to-emergency-call timing delay before and during the COVID-19 pandemic (P<0.005 for all the items). Differently from 2018-2019, during the pandemic, hypertension and dyspnea (P=0.002 versus P=0.490 and P=0.001 vs. P=0.761 for 2018-2019 and 2020, respectively) did not result as predictors of delay in symptoms-to-emergency-call timing. Among these predictors, only the atypical symptoms (HR 3.36; 95% CI: 1.172-9.667, P=0.024) in 2020 and the dyspnea (HR 2.64; 95% CI: 1.345-5.190, P=0.005) in 2018-2019 resulted significantly associated with higher mortality. Finally, the family attendance at the onset of the symptoms resulted in a reduction in symptoms-to-emergency-call timing (in 2020 P<0.001; CI: -1710.73; -493.19) and in a trend of reduced mortality (HR 0.31; 95% CI: 0.089-1.079, P=0.066) in 2020.
CONCLUSIONS: During the COVID-19 outbreak, atypical symptoms and family attendance at ACS onset were identified, respectively, as adverse and favorable predictors of symptoms-to-emergency-call timing delay and mortality.