Assiut University Registry for Acute Coronary Syndrome Patients during COVID-19 Pandemic: A Prospective Observational Study

Background: The COVID-19 pandemic affected management protocols for acute coronary syndrome (ACS) patients worldwide, including Egypt, to provide optimal management for this critical group of patients while minimizing harm to patients and healthcare workers. We aimed to investigate the impact of the COVID-19 pandemic on the management strategies and outcomes of ACS patients in a university hospital. In this observational prospective longitudinal cohort study, all ACS patients admitted to a university hospital within 15 months during the COVID-19 pandemic were recruited. All patients were subjected to a full medical history, ECG, echocardiography, routine investigations, and follow-up for in-hospital major complications and 12-month adverse events. They were screened for COVID-19 symptoms, and CT chest and PCR tests were conducted for suspected cases.Results: A total of 2252 patients were recruited. ACS was more prevalent among rural, elderly, male, and hypertensive patients. Among them, 1482 (65.9%) had STEMI, with 74.9% undergoing primary PCI and 15.4% receiving thrombolytic therapy. Regarding COVID status, 690 (30.6%) of patients were suspected based on symptoms. A multivariate logistic regression model showed that COVID-19 was associated with more in-hospital complications and more MACE on 12-month follow-up (OR=5.021, 95%CI= 1.995 – 8.661, P < 0.001). The number of ACS admissions and the percentage of primary PCI procedures performed during the pandemic both decreased in comparison to before and after the pandemic (P value=0.044).Conclusion: COVID-19 strongly affected management strategies as STEMI patients with suspected COVID-19 infection received more thrombolytic therapy and underwent less PPCI, in addition to higher in-hospital and 12-month MACE.