The Effect of Covid-19 Pandemic on Treatment Management, and Clinical Outcome of Patients with Acute Coronary Syndromes (ACS): A Systematic Review and Meta-Analysis

Abstract

This systematic review and meta-analysis aimed to summarize the available evidence on the impacts of the COVID-19 pandemic on treatment management, and clinical outcomes among patients with acute coronary syndrome (ACS). PubMed and ScienceDirect were searched from January 2020 to September 2021 to identify relevant studies. For dichotomous variables, meta-analysis was performed using the random-effects model. For continuous variables, descriptive synthesis was conducted. Sixty-three articles were included in the review. The time from symptom onset to First Medical Contact (FMC) was significantly longer during the COVID-19 pandemic in 50% of the studies (17/34). One-third of the studies (9/26) observed significantly longer door-to-balloon (DTB) times during the pandemic. Approximately 73 % of studies (11/15) indicated a significantly longer total ischemic time during the pandemic era. The pooled results did not show a significant difference in in-hospital mortality during the COVID-19 pandemic among patients with ST-elevation myocardial infarction (STEMI) (RD = -0.01, 95% CI -0.02, 0.00) and non-ST-elevation myocardial infarction (NSTEMI) (RD = -0.01, 95% CI -0.01, 0.00). No significant difference in the proportion of patients who underwent Percutaneous Coronary Intervention (PCI) was found across the pandemic period. The COVID-19 pandemic seemed to prolong the time to receive treatment in most settings. Education campaigns and well-planned ACS pathways to ensure timely treatment for patients with ACS during the pandemic/crisis are warranted.