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

DOI: 10.23736/S2724-5683.22.05985-3


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

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