Acil Serviste Covid-19 Salgını Öncesi ve Covid-19 Salgını Döneminde Akut Koroner Sendrom Tanısı Alan Hastaların Epidemiyolojik İncelenmesi

Öz

Kardiyovasküler hastalıklar; yetişkinlerde mortalite ve morbiditenin başlıca nedeni olup Türkiye'deki tüm ölümlerin ise yaklaşık yarısı kardiyovasküler hastalıklardan kaynaklanmaktadır. Çalışmamız kapsamında, Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servisi'ne COVID-19 salgını öncesi ve sonrası 1 yıllık süreçte başvuran ve akut koroner sendrom tanısıyla değerlendirilen hastaların epidemiyolojik olarak değerlendirilmesi amaçlanmıştır. Acil servise, COVID-19 pandemisi öncesi 01.04.2019-31.03.2020 ve pandemi sonrası 01.04.2020-31.03.2021 tarihleri arasında başvurarak akut koroner sendrom tanısı konulan hastaların dosyaları retrospektif olarak incelenmiş olup hastaların yaş, cinsiyet, laboratuvar değerleri (tam kan sayımı, troponin, kreatinin kinaz, D-dimer, üre, kreatin, kreatinin kinaz izoenzim-MB), başvuru anındaki COVID-19 PCR, eşlik eden hastalıklar, başvuru şikayeti ve EKG bulguları kaydedilmiştir. Hastaların %72,7’sinin erkek cinsiyette olduğu; %31,8’inin sigara içtiği, %2,6’sının morbid obez olduğu görülmüştür. Hastaların yaş dağılımında, COVID-19 öncesi ve sonrası grup karşılaştırılmasında istatistiksel fark belirlenmiştir Akut koroner sendrom tanısı konulan hastaların %84,4 oranında tipik göğüs ağrısı şikayeti ile hastaneye başvurdukları görülmüş olup COVID-19 sonrası hastalarda; NSTEMI tanıları artarken, STEMI ve USAP tanıları ise azalma saptanmıştır. Hasta sonlanımı olarak bakıldığında ise COVID-19 sonrası hastalarda sevk oranı azalmış ancak ölüm oranının ise arttığı görülmüştür. COVID-19 enfeksiyonları akut koroner sendrom, miyokard enfeksiyonu, kalp yetersizliği ve aritmiler de dahil birçok klinik sonuçla beraber kardiyak oksijen sunum yetersizliği, artmış koagülabilite, enflamasyon, sitokin fırtınasına bağlı olarak kardiyak hasara sebep olmaktadır. Çalışmamızdan elde edilen verilerin ulusal ve uluslararası literatüre katkı sağlamakta olduğunu ve olası risk faktörlerinin belirlenmesi ile acil hekimlerine yol gösterici olacağı düşünülmektedir.

Anahtar Kelimeler

• acil servis
• akut koroner sendrom
• COVID-19

Epidemiological Investigation of Patients Diagnosed with Acute Coronary Syndrome in the Emergency Department Before and After the COVID-19 Outbreak

Öz

Cardiovascular diseases are the leading cause of mortality and morbidity in adults and approximately half of all deaths in Turkey are due to cardiovascular diseases. Within the scope of our study, we aimed to evaluate an epidemiological analysis of the patients admitted to the Emergency Department of Bursa Uludag University Medical Faculty in the 1-year period before and after the COVID-19 pandemic and evaluated with a diagnosis of acute coronary syndrome. The records of patients who were admitted to the emergency department between 01.04.2019-31.03.2020 before the COVID-19 pandemic and 01.04.2020-31.03.2021 after the pandemic and diagnosed with acute coronary syndrome were retrospectively analyzed. Age, gender, laboratory values (complete blood count, troponin, creatinine kinase, D-dimer, urea, creatine, creatinine kinase isoenzyme-MB), COVID-19 PCR at the time of admission, comorbidities, complaints at admission and ECG findings were recorded. It was observed that 72.7% of the patients were male, 31.8% were smokers and 2.6% were morbidly obese. It was observed that 84.4% of the patients diagnosed with acute coronary syndrome were admitted to the hospital with typical chest pain, and NSTEMI diagnoses increased, while STEMI and USAP diagnoses decreased in patients after COVID-19. In terms of patient outcome, the referral rate to another hospital was decreased in patients after COVID-19, but the mortality rate was increased. COVID-19 infections cause cardiac damage due to cardiac oxygen insufficiency, increased coagulability, inflammation, cytokine storm, cardiac oxygen insufficiency, increased coagulability, inflammation, and cytokine storm, with many clinical outcomes including acute coronary syndrome, myocardial infection, heart failure, and arrhythmias. We believe that the data obtained from our study contributes to the national and international literature and will guide emergency physicians by identifying possible risk factors.

Anahtar Kelimeler

• acute coronary syndrome
• emergency department
• COVID-19

Kaynakça

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