There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses.
We investigated the incidence, ...clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department.
We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non-COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes.
We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% 95% confidence interval {CI} 1.21-1.78%). This incidence was lower than that observed in non-COVID-19 patients (3.64% 95% CI 3.54-3.74%; odds ratio OR 0.40 95% CI 0.33-0.49). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR aOR 6.36 95% CI 1.84-22.1, aOR 4.63 95% CI 1.88-11.4, and aOR 2.46 95% CI 1.15-5.25). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21-0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84-12.4).
The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.
Highlights * Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of ...SARS-CoV-19 still remain to be defined. * We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. * We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation. Author Affiliation: (a) Hospital Clinic, Barcelona, Spain (b) Hospital Clinico San Carlos, Madrid, Spain (c) Hospital General de Alicante, Spain (d) Hospital Universitario de Canarias, Tenerife, Spain (e) Hospital Universitario Severo Ochoa de Leganes, Madrid, Spain (f) Hospital General Universitario Reina Sofia, Murcia, Spain (g) Complejo Asistencial de Soria, Spain (h) Hospital Universitario Rey Juan Carlos, Madrid, Spain (i) Hospital San Pedro, Logrono, Spain (j) Hospital de Leon, Spain (k) Hospital de la Princesa, Madrid, Spain (l) Hospital Clinico San Carlos, Madrid, Spain (m) Hospital de Fuenlabrada, Madrid, Spain (n) Hospital Clinico Universitario Lozano Blesa, Spain (o) Hospital Clinico Universitario de Salamanca, Spain (p) Complejo Hospitalario Universitario de A Coruna, Spain (q) Hospital Universitario de Bellvitge de l'Hospitalet de Llobregat, Barcelona, Spain (r) Hospital de la Vega Baja de Orihuela, Alicante, Spain (s) Hospital Virgen de los Lirios de Alcoy, Alicante, Spain (t) Hospital Francesc de Borja de Gandia, Valencia, Spain (u) Hospital Doctor Peset, Valencia, Spain (v) Hospital la Fe, Valencia, Spain (w) Hospital Reina Sofia, Murcia, Spain (x) Hospital General de Albacete, Spain (y) Hospital del Vinalopo de Elche, Alicante, Spain (z) Hospital de Torrevieja, Alicante, Spain (aa) Hospital Universitari de Vic, Barcelona, Spain (ab) Hospital General de Alicante, Spain (ac) Hospital Marina Baixa de Villajoyosa, Alicante, Spain (ad) Hospital Arnau de Vilanova, Valencia, Spain (ae) Hospital Clinic de Barcelona, Spain (af) Hospital Universitario LucusAugusti, Lugo, Spain (ag) Hospital de Henares, Madrid, Spain (ah) Hospital Comarcal El Escorial, Madrid, Spain (ai) Hospital Universitario de Burgos, Spain (aj) Hospital Costa del Sol de Marbella, Malaga, Spain (ak) Hospital de Lliria, Valencia, Spain (al) Hospital de Requena, Valencia, Spain (am) Hospital Clinico de Valencia, Spain (an) Hospital Universitario La Ribera, Valencia, Spain (ao) Hospital del Mar, Barcelona, Spain (ap) Hospital Universitario La Paz, Madrid, Spain (aq) Hospital Santa Tecla, Tarragona, Spain (ar) Hospital Rio Hortega, Valladolid, Spain (as) Hospital General de Elche, Alicante, Spain (at) Hospital Universitario Central Asturias, Oviedo, Spain (au) Hospital de Parla, Madrid, Spain (av) Hospital Virgen de la Luz, Cuenca, Spain (aw) Hospital Joan XXIII, Tarragona, Spain (ax) Hospital Universitario de Canarias, Tenerife, Spain (ay) Clinica Universidad Navarra, Madrid, Spain (az) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (ba) Hospital Juan Ramon Jimenez, Huelva, Spain (bb) Hospital Doctor Josep Trueta, Girona, Spain (bc) Clinica Sagrada Familia, Barcelona, Spain (bd) Hospital Severo Ochoa de Leganes, Madrid, Spain (be) Hospital GermansTrias i Pujol de Badalona, Barcelona, Spain (bf) Hospital Universitario Sant Joan, Alicante, Spain (bg) Hospital Doctor Negrin, Las Palmas de Gran Canaria, Spain (bh) Hospital Nuestra Senora del Prado de Talavera de la Reina, Toledo, Spain (bi) Hospital Valle de los Pedroches de Pozoblanco, Jaen, Spain (bj) Hospital Regional Universitario de Malaga, Spain (bk) Hospital Lluis Alcanyis de Xativa, Valencia, Spain (bl) Hospital Alvaro Cunqueiro de Vigo, Pontevedra, Spain (bm) Consorci Hospitalari de Terrassa, Barcelona, Spain (bn) Hospital de Denia, Alicante, Spain (bo) Hospital de Gijon, Asturias, Spain (bp) Hospital Virgen de la Arrixaca, Murcia, Spain (a) Emergency Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain (b) Emergency Department, Hospital General de Alicante, University Miguel Hernandez, Elche, Alicante, Spain (c) Emergency Department, Hospital General UniversitarioReina Sofia, Murcia, Spain (d) Emergency Department, Hospital Universitario de Canarias, Tenerife, Spain (e) Emergency Department, Hospital UniversitarioSevero Ochoa, Universidad Alfonso X, Madrid, Spain (f) Emergency Department, Hospital Clinico San Carlos, IDISSC, Univesdad Complutense, Madrid, Spain * Corresponding author at: Emergency Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Article History: Received 27 August 2020; Revised 18 December 2020; Accepted 24 January 2021 Byline: Oscar Miro omiro@clinic.cat (a,*), Pere Llorens (b), Sonia Jimenez (a), Pascual Pinera (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Francisco Javier Martin-Sanchez (f), Juan Gonzalez del Castillo (f), Oscar Miro (a), Sonia Jimenez (a), Juan Gonzalez del Castillo (b), Francisco Javier Martin-Sanchez (b), Pere Llorens (c), Guillermo Burillo-Putze (d), Alfonso Martin (e), Pascual Pinera Salmeron (f), Fahd Beddar Chaib (g), Enrique del Hoyo Pelaez (g), Belen Rodriguez Miranda (h), Alejandra Sanchez Arias (h), Noemi Ruiz de Lobera (i), Marta Iglesias Vela (j), Laura Hernando Lopez (j), Carmen del Arco Galan (k), Guillermo Fernandez Jimenez (k), E. Jorge Garcia Lamberechts (l), Marcos Fragiel (l), Maria Jesus Dominguez (m), Maria Eugenia Barrero Ramos (m), Jose Maria Ferreras Amez (n), Belen Arribas Entrala (n), Angel Garcia Garcia (o), Marta Fuentes de Frutos (o), Ricardo Calvo Lopez (p), Javier Jacob-Rodriguez (q), Ferran Llopis-Roca (q), Maria Carmen Ponce (r), Napoleon Melendez (s), Maria Jose Fortuny Bayarri (t), Francisco Jose Salvador Suarez (t), Maria Luisa Lopez Grima (u), M*. Angeles Juan Gomez (u), Javier Millan (v), Jose A. Sanchez Nicolas (w), Paula Lazaro Aragues (w), Francisco Javier Lucas-Imbernon (x), Francisco Javier Lucas-Galan (x), Blas Jimenez (y), Blas Jimenez (z), Rigoberto del Rio (z), Lluis LLauger Garcia (aa), Begona Espinosa (ab), Ana Belen Paya (ab), Juan Miguel Porrino (ac), Maria Rosales Maestre (ac), Maria Jose Cano Cano (ad), Rosa Sorando Serra (ad), Carlos Cardozo (ae), Juan Jose Lopez Diaz (af), Martin Ruiz Grinspan (ag), Cristobal M. Rodriguez Leal (ag), Sara Gayoso Martin (ah), Silvia Ortiz Zamorano (ah), Maria Pilar Lopez Diaz (ai), Carmen Aguera Urbano (aj), Elisa Delgado Padial (aj), Ana Peiro Gomez (ak), Elena Gonzalo Bellver (ak), Laura Ejarque Martinez (al), Maribel Marzo Lambies (al), Jose Noceda (am), Jose Vicente Braso Aznar (an), Jose Luis Ruiz Lopez (an), Alfons Aguirre Tejedo (ao), Isabel Cirera Lorenzo (ao), Alejandro Martin Quiros (ap), Elena Munoz del Val (ap), Enrique Martin Mojarro (aq), Brigitte Silvana Alarcon Jimenez (aq), Virginia Carbajosa (ar), Susana Sanchez Ramon (ar), Matilde Gonzalez Tejera (as), Pablo Herrero Puente (at), Desire Maria Velarde Herrera (at), Francisco Javier Teigell Munoz (au), Juan Carlos Reparaz Gonzalez (au), Felix Gonzalez Martinez (av), Diana Moya Olmeda (av), Anna Palau (aw), Patricia Eiroa Hernandez (ax), Marcos Exposito Rodriguez (ax), Nieves Lopez Laguna (ay), Maria Garcia-Uria (ay), Josep Guardiola (az), Polo Higa Sansome (az), Maria Jose Marchena Gonzalez (ba), EissaJaloud Saavedra (ba), Maria Adroher (bb), Ester Soy Ferrer (bb), Arturo Huertas (bc), Raquel Torres Garate (bd), Beatriz Valle Borrego (bd), Josep Maria ModolDeltell (be), Samuel Olmos Soto (be), Elena Diaz Fernandez (bf), Jose Pavon Monzo (bg), Nayra Cabrera Gonzalez (bg), Ricardo Juarez (bh), Jorge Pedraza Garcia (bi), Manuel Salido (bi), Miguel Moreno Fernandez (bj), Carles Perez (bk), Maria Teresa Maza Vera (bl), Raquel Rodriguez Calveiro (bl), Josep Tost (bm), Antonio Barcelo (bn), Rosario Carrio (bo), Eva Quero Moto (bp)
There is a lack of knowledge about the real incidence of acute coronary syndrome (ACS) in patients with COVID-19, their clinical characteristics, and their prognoses.
We investigated the incidence, ...clinical characteristics, risk factors, and outcomes of ACS in patients with COVID-19 in the emergency department.
We retrospectively reviewed all COVID-19 patients diagnosed with ACS in 62 Spanish emergency departments between March and April 2020 (the first wave of COVID-19). We formed 2 control groups: COVID-19 patients without ACS (control A) and non–COVID-19 patients with ACS (control B). Unadjusted comparisons between cases and control subjects were performed regarding 58 characteristics and outcomes.
We identified 110 patients with ACS in 74,814 patients with COVID-19 attending the ED (1.48% 95% confidence interval {CI} 1.21–1.78%). This incidence was lower than that observed in non–COVID-19 patients (3.64% 95% CI 3.54–3.74%; odds ratio OR 0.40 95% CI 0.33–0.49). The clinical characteristics of patients with COVID-19 associated with a higher risk of presenting ACS were: previous coronary artery disease, age ≥60 years, hypertension, chest pain, raised troponin, and hypoxemia. The need for hospitalization and admission to intensive care and in-hospital mortality were higher in cases than in control group A (adjusted OR aOR 6.36 95% CI 1.84–22.1, aOR 4.63 95% CI 1.88–11.4, and aOR 2.46 95% CI 1.15–5.25). When comparing cases with control group B, the aOR of admission to intensive care was 0.41 (95% CI 0.21–0.80), while the aOR for in-hospital mortality was 5.94 (95% CI 2.84–12.4).
The incidence of ACS in patients with COVID-19 attending the emergency department was low, around 1.48%, but could be increased in some circumstances. Patients with COVID-19 with ACS had a worse prognosis than control subjects with higher in-hospital mortality.
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