Management and Outcomes of Acute Coronary Syndrome during and after the COVID-19 Pandemic in Kurume City: A Multicenter Observational Study.

BACKGROUND: The impact of the coronavirus disease 2019 (COVID-19) pandemic on acute coronary syndrome (ACS) care has varied widely across regions. Data from stable regional healthcare systems remain limited, particularly regarding potential delayed effects after the acute pandemic phase. METHODS: We conducted a retrospective, population-based observational study of percutaneous coronary intervention (PCI)-treated ACS in Kurume City, Japan, across three periods: pre-pandemic (2019), pandemic (2020-2021), and post-restriction (2022). PCI data were collected from all four PCI-capable hospitals in the region. The primary endpoint was in-hospital mortality among ACS patients. Secondary endpoints included ACS subtype distribution and use of mechanical circulatory support (MCS). RESULTS: A total of 4,694 PCI procedures were performed between 2019 and 2022, including 1,692 for ACS. Annual PCI volume and the proportion performed for ACS (34.1%-38.6%) remained stable. The proportion of ST-segment elevation myocardial infarction was higher in 2020 and remained elevated in 2022 compared with 2019 (p=0.015). In-hospital mortality among ACS patients was comparable during the pandemic years but increased significantly in 2022 (7.4% vs 2.3%-4.0%; p=0.0006), even after excluding post-cardiac arrest syndrome. Rates of MCS use did not differ significantly across years. Emergency medical transport times increased modestly. CONCLUSION: In this regional healthcare system, the COVID-19 pandemic did not substantially disrupt emergent coronary revascularization or worsen short-term outcomes of PCI-treated ACS during the acute phase. However, in-hospital mortality increased in the post-restriction period, suggesting delayed cardiovascular consequences of the pandemic.