Acute Coronary Heart Syndrom (ACS): Hospitalizations in Germany Before and During Covd-19 Pandemic

OBJECTIVES: Acute coronary syndrome (ACS) is a frequent cause of hospitalization in Germany. It is differentiated into instable angina (IA) and acute myocardial infarction (AMI), which again may be transmural (STEMI) nor not (NSTEMI).

Revascularization by a catheter procedure (PCI) is a treatment option. Catheterization is also used to firstly diagnose the underlying coronary artery disease (CAD).

Last decade the incidence of ACS hospitalizations slightly increased in Germany, but catheter procedures grew faster. Since 2020 Covid-19 pandemic changed life by social distancing and hospitalizations were an infection risk. We examined incidence change of ACS hospitalizations and withgoing procedures.

METHODS: Data from Federal Statistical-Office and Report-Browser 2005-2021 of the German DRG-Institute (InEK) and were analyzed ACS and catheter procedures. Analysis with Microsoft Excel® (v2019).

RESULTS: Inpatient cases with main diagnosis ACS peaked in 2012 with 222,432 and decreased ever since to 193,383 (-13.1%) in 2021. Biggest yearly reduction 2019 to 2020 by 14,452 cases (-7.0%). From 2019 to 2021 instable angina cases were reduced by 16.1% (-15,711 cases), NSTEMI by 9.1% (-12,780 cases) and STEMI by 2.4% (-1,614 cases). Demographics remained unaffected despite the case-drop: Average age AI in 2019: 68.6y, in 2021: 68.5y. NSTEMI with 71.6y and STEMI with 65.8y unchanged. Same for gender distribution: Share of female patients in 2021 (change from 2019): AI 34.4 (-0.2%), NSTEMI 34.3% (+0.3%) and STEMI 29.0% (-0.3%).

Comorbidity and complication level (PCCL) was 2021 (change from 2019): AI 0.41 (-0.08), NSTEMI 1.17 (-0.13) and STEMI 1.23 (-0.19).

Cases with PCI dropped from 2019 to 2021 by 6.6% to 348,056 and cases with only diagnostic catheter by 5.5% to 533,062.

CONCLUSIONS: In the period of Covid-19 pandemic the hospitalizations due to ACS dropped moderately, also PCIs and catheters, without changes in age or gender distribution. But cases had in average less comorbidities and complications. This phenomenon remains unexplained.