Background: The SARS-CoV2 pandemic has substantially changed the practice of medicine worldwide. Pandemic strategies vary greatly not only between countries, but also between counties as well as local hospitals. Furthermore, the incidence of COVID19 cases is enormously different depending on country and county. It can be challenging to differentiate signs of true acute coronary syndromes (ACS: NSTEMI, STEMI, UA) from COVID19 infection, since symptoms like chest pain and dyspnea are similar. Furthermore, patient and physician performance might be sustainably affected and biased by the extensive effects of SARS-CoV2 pandemic possibly leading to under- or overtreatment of cardiac patients.

Objective: To investigate the incidence, characteristics, and outcome of ACS during SARS-CoV2-pandemic in a high-volume PCI center in the state of Thuringia before, during, and after the SARS-CoV2-pandemic-related lockdown.

Methods: This study is an all comers, cohort study at the University Heart Center, Friedrich-Schiller-University Jena, Germany. The University Hospital Jena implemented a prospective STEMI registry in 2015 that was expanded to NSTEMI and cardiogenic shock patients. Administrative, procedural, therapeutic, and clinical parameters are prospectively and anonymously recorded. Unreasonable treatment delays (calculated as cumulative time in any prolongation in timely diagnosis) are determined. Two time frames of local ACS care were compared with a reference group from the year 2019 of our registry: (1) lock-down due to SARS-CoV2-pandemic, months 03-04/2020 vs. 03-04/2019; and (2) easing of lock-down measures during months 05-06/2020 vs. 05-06/2019.

Results: Altogether 417 patients presented with ACS during the months 03-06 of 2019 and 2020. Table 1 shows baseline clinical characteristics of the patient cohort, which did not show any difference during and after the lockdown compared to the reference group of the year 2019. There was a significant reduction of all ACS cases, and its subtypes, from ~118 patients before vs. 79 cases during the lockdown, which quickly normalized during the period of easing lockdown measures up to 109 cases (Tab.2). The decline of ACS cases was observed particularly in the STEMI cohort with a reduction by 46 % (N = 37 vs. N = 20, Table 2). Moreover, patients avoided seeking medical attention at the emergency room during the lockdown with a reduction of self-presenters in the total ACS cohort (22.0 vs. 14.2 %, p = 0.0411) and particularly in the STEMI cohort (21.6 vs. 0 %, p = 0.055). STEMI patients also avoided first medical contact with their general practitioner (25.7 % vs. 5 %, p = 0.007) as an alternative. After the lockdown, patients were less reluctant to show up at the ER, but cases were still not normalized in the following two months (Tab. 2). On the other hand, diagnostic work-up, including invasive coronary angiography and indication for PCI, did not differ with the exception for performed thoracic CT scans, which almost doubled during the pandemia-related lockdown compared to 2019 (Tab. 2). Due to the sample size statistical significance was not reached for all parameters.

Conclusion: Patients with signs of acute coronary syndrome where overly reluctant to seek medical attention during the COVID19-lockdown measures despite a very low overall incidence of COVID19 infections in Thuringia. Diagnostic work-up of ACS patients was not impaired and carried out at a high standard.