CLINICAL PECULIARITIES OF ACUTE CORONARY SYNDROME DURING COVID-19 MANIFESTATION

The purpose of the work: to study the dependence of 30-day survival of patients with acute coronary syndrome and COVID-19 based on the timeliness of seeking medical help, clinical manifestations, timeliness/delay of reperfusion. Participants and methods. The study included patients with acute coronary syndrome who underwent reperfusion interventions (n=100), the average age of the study participants was 63.5±4.8 years. The study participants were divided into groups: the main group included (n=50) patients with acute coronary syndrome during the manifestation of COVID-19, and a comparison group (n=50) involving patients with acute coronary syndrome without respiratory viral infection. The material for the analysis was as followes: medical history, physical, clinical, laboratory and instrumental examination, protocols of interventional interventions or coronary bypass, results of polymerase chain tests for confirmation of COVID-19. Results. The analysis of complaints revealed that periodic anginal pain (p=0.003, χ²=9.06) and the presence of heart rhythm disorders (p=0.02, χ²=5.23) were significantly more common in patients of the comparison group. Tthe proportion of patients who underwent reperfusion within 6 hours of anginal pain onset was significantly higher in the comparison group (p=0.0001, χ²=67.22). In contrast, the proportion of patients who underwent reperfusion more than 6 hours after onset was significantly higher in the main group (p=0.004, χ²=8.23). The odds ratio (OR) analysis revealed that the risk of fatal events was 3.3 times higher in patients who underwent reperfusion after 6 hours (OR=3.30; 95% CI: 1.21–9.14, p=0.016, χ²=5.76). Moreover, in patients who died, the OR indicated that the risk of fatal events was 2.56 times higher compared to patients in the main group who also had reperfusion delayed by more than 6 hours (OR=2.56; 95% CI: 1.30–5.01, p=0.0069, χ²=7.29). Conclusions. The study identified significant differences in the complaints expressed by patients with acute coronary syndrome, with and without COVID-19. It was found that periodic anginal pain and heart rhythm disorders were significantly more common in the comparison group. The determined odds ratios indicated that the risk of fatal events was 3.3 times higher in patients who underwent reperfusion after 6 hours. The retrospectively calculated odd ratios showed that the risk of fatal events in deceased patients, considering the timing of reperfusion, was 2.56 times higher compared to patients in the main group, who also underwent reperfusion after 6 hours.