Management of Acute Coronary Syndrome During the MERS-CoV Outbreak - Single-Center Experience

Abstract

Background: During the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak of 2014, tertiary care cardiac centers shouldered the responsibility of caring for patients presenting with Acute Coronary Syndromes (ACS). This entailed designing algorithms that ensured timely management of patients with ACS in the setting of an emerging novel viral infection that was rapidly spreading within the community with a high infectivity and case fatality rate. The objective of this study is to describe a single center experience and the adopted pathway for the management of ACS.

Methods: This is a single center retrospective observational study of all patients who were admitted between March 1, 2014 and May 31, 2014 with an ACS. Total ACS admissions, bed turnover, procedures and healthcare personnels' infection rates were obtained from the annual statistics database and employee health records. All baseline characteristics, therapy received, outcomes and MERS-CoV status were obtained from the chart review.

Results: A total of 148 patients with a diagnosis of ACS were admitted during that period of time. Of those, 59 had STEMI, 42 had NSTEMI and 47 had unstable angina. PCI was performed in 74, coronary artery bypass grafting (CABG) in 28 and conservative therapy was prescribed for 46 patients. The bed turnover was no higher than the previous or subsequent two months suggesting no change in practice. The infection rate of MERS-CoV was zero for healthcare workers.

Conclusions: In times of a national health crisis it is imperative that best practices are upheld to sustain existing resources, reduce bed occupancy and preserve medical personnel. A key component of such a strategy depends on assigning centers dedicated to isolating and treating the highly infectious disease outbreak while allowing other centers to provide expeditious cardiac care.

Keywords: Acute coronary syndrome; Bed utilization; Infection control; MERS CoV; Percutaneous coronary interventions.