ORIGINAL ARTICLE   

Minerva Cardiology and Angiology 2023 February;71(1):12-9

DOI: 10.23736/S2724-5683.22.05985-3

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Symptoms-to-emergency-call timing delay in acute coronary syndrome before and during COVID-19: independent predictors and their impact on mortality

Alessandro STICCHI ^{1, 2, 3} ✉, Francesco COSTA ⁴, Saverio MUSCOLI ⁵, Filippo ZILIO ⁶, Andrea BUONO ⁷, Rossella RUGGIERO ³, Alessandra SCOCCIA ³, Alessandro CARACCIOLO ⁴, Roberto LICORDARI ⁴, Valeria CAMMALLERI ⁵, Fortunato IACOVELLI ⁸, Marco LOFFI ⁹, Domenico SCORDINO ¹⁰, Jayme FERRO ¹¹, Andrea ROGNONI ¹², Stefano NAVA ¹³, Stefano ALBANI ¹⁴, Marco PAVANI ¹⁵, Iginio COLAIORI ¹⁶, Stefano BENENATI ¹⁷, Fabio PESCETELLI ¹⁷, Vincenzo DE MARZO ¹⁷, Marco BORGHESI ⁶, Valentina REGAZZONI ⁹, Antonia MANNARINI ⁸, Francesco SPIONE ⁸, Baldassarre DORONZO ¹⁵, Michele de BENEDICTIS ¹⁵, Roberto BONMASSARI ⁶, Gian B. DANZI ⁹, Mario GALLI ¹¹, Alfonso IELASI ⁷, Giuseppe MUSUMECI ¹⁴, Fabrizio TOMAI ¹⁰, Antonio MICARI ⁴, Vincenzo PASCERI ¹⁸, Giuseppe PATTI ¹², Italo PORTO ¹⁷, Gianluca CAMPO ¹⁹, Antonio COLOMBO ¹, Francesco GIANNINI ³

¹ Humanitas Research Hospital IRCCS, Milan, Italy; ² Centro per la Lotta Contro L’Infarto (CLI) Foundation, Rome, Italy; ³ GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; ⁴ Department of Clinical and Experimental Medicine, G. Martino Polyclinic, University of Messina, Messina, Italy; ⁵ Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy; ⁶ Unit of Cardiology, Santa Chiara Hospital, Trento, Italy; ⁷ Sant’Ambrogio Clinical Institute, Milan, Italy; ⁸ Division of Cardiology, Cardiothoracic Department, Polyclinic University of Bari, Bari, Italy; ⁹ Department of Cardiology, Hospital of Cremona, Cremona, Italy; ¹⁰ Division of Cardiology, Aurelia Hospital, Rome, Italy; ¹¹ UOSD Cardiology, Department of Emergency, Intensive Care and Anesthesia, Hemodynamics Laboratory, ASST Lariana, S. Anna Hospital, Como, Italy; ¹² AOU Maggiore della Carità, Novara, Italy; ¹³ Division of Invasive Cardiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; ¹⁴ Mauriziano Hospital, Turin, Italy; ¹⁵ SS Annunziata Civil Hospital, Savigliano, Cuneo, Italy; ¹⁶ AUSL IRCCS Reggio Emilia, Reggio Emilia, Italy; ¹⁷ CardioToracoVascular Department, IRCCS San Martino University Hospital, Genoa, Italy; ¹⁸ San Filippo Neri Hospital, Rome, Italy; ¹⁹ Cardiovascular Institute, AOU Ferrara, Cona, Ferrara, Italy

BACKGROUND: The COVID-19 pandemic severely impacted global health. The aim of this study was to compare predictors of symptoms-to-emergency-call timing delay in acute coronary syndrome (ACS) and their impact on mortality before and during the COVID-19 outbreak.
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.

KEY WORDS: Acute coronary syndrome; COVID-19; Mortality