Impact of COVID-19 pandemic on acute coronary syndrome presentation and its management in saudi arabia “a local experience”

Background: The impact of COVID 19 pandemic on all acute coronary syndrome (ACS) presentations and its management in Saudi Arabia is still unknown. Objectives: To find furthermore in the rate of ACS presentation, including ST-segment elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during this outbreak and its effect on the management. Materials and Methods: We conducted a retrospective analysis of consecutive patients presenting with ACS requiring cardiac catheterization in three primary percutaneous coronary intervention (PCI) capable centers from March to April 2020 compared to the same period from 2019. Results: We found a numeric downward shift of 62.2% in all ACS presentations, including ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA) during the study time when compared to its equivalent period in 2019, (P = 0.329). The door-to-balloon median time in STEMIs was statistically insignificant between the two comparison groups, but more patients in 2020 had a delay in transfer with either evaluating a suspected COVID-19 case or more time to prepare the cath lab staff protected precaution (P = 0.002). We illustrated a significant delay in time to seek medical attention from onset of symptoms by patients with NSTEMI and UA in 2020, with a median of 36 h (24, 96) versus 12 h (2, 96) in 2019 (P < 0.001). Moreover, the rate of female patients with ACS cases requiring PCI yields an increase in 2020 (P < 0.001). Overall, revascularization management of ACS patients presenting before and during the pandemic showed no difference. Conclusion: ACS admissions have been reduced during the COVID-19 pandemic, with no much impact on the overall management of revascularization. Efforts should be directed to understand the underlying mechanisms of these results to improve the short and long-term outcomes of these high-risk groups in these challenging times.