Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study.

BACKGROUND: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

P981Lvot area measurement using gated ct data reclassifies aortic stenosis severity as graded by echocardiography.

BACKGROUND: Measurement of left ventricular outflow tract (LVOT) diameter and area for estimation of aortic valve area (AVA) using transthoracic echocardiography (TTE) and the continuity equation assumes circular LVOT. The use of direct planimetric measurement of LVOT area by gated-CT can theoretically improve accuracy of AVA calculation. PURPOSE: We aim to assess reproducibility of LVOT echo measurement and its correlation and agreement with Gated CT measurements. In the subgroup with aortic stenosis (AS) we secondarily assessed the potential change in AS severity using LVOT area by CT instead of TTE in the continuity equation. METHODS: We retrospectively studied 93 patients, 43 of whom with severe AS. LVOT Area was measured with 2D TTE by 2 expert echocardiographers and gated-CT by 2 expert radiologists; inter-reader agreement and inter-method (Echo vs gated CT) agreement and correlation were measured. Finally we used the measurement of CT scan in the continuity equation instead of TTE measurement to assess potential reclassification of AS severity. RESULTS: Mean age was 78±11. Table shows inter-reader and inter-method agreement and correlation.The correlation between 2 echocardiophers for LVOT measurements was good (rho = 0,77) although not perfect. Out of 43 severe AS, defined as AVA<1 cm2 using TTE in the continuity equation, 18 were reclassified by gated-CT LVOT measurements into moderate AS. This was due to gated-CT LVOT area resulting on average 1.4 cm2 larger than LVOT area by TTE. CONCLUSION: LVOT is elliptical and TTE tends to underestimate LVOT area and AVA due to the measurement of the shorter diameter of this ellipse. CT scan can provide more geometrically accurate measurement and requires different cut-offs compared with traditional TTE AVA measurement. By the way, in the current study the LVOT area by CT was on average 38% larger of the LVOT area measured by TTE. Such correcting factor (increase TTE LVOT area by 38%) should apparently be used to assess anatomical true planimetric area to be compared with gated-CT LVOT.summary tableTTE Inter-reader correlation LVOT area (Spearman rho)0.77TTE reader A vs CT 3-chamber equivalent correlation (Spearman rho)0.49TTE reader B vs CT 3-chamber equivalent correlation (Spearman rho)0.38TTE reader A area vs CT planimetric area correlation (Spearman rho)0.41TTE reader B area vs CT planimetric area correlation (Spearman rho)0.31Mean LVOT Area by TTE reader A3,60SD 0,6038%Mean LVOT Area by CT scan4,99SD 0,98 Abstract P981 Figure.summary table.Abstract P981 Figure.