ABSTRACT
Background: The coronavirus disease-2019 pandemic has restricted availability of intensive care unit resources. Symptomatic patients with coronary artery disease considered surgical candidates have therefore needed revascularization with percutaneous coronary intervention (PCI). We describe demographics/in-hospital clinical outcomes of this novel cohort. Methods: From March 1, 2020, to May 31, 2020, anonymized data of 171 patients in 38 U.K. centers were enrolled in a prospective registry. All were considered surgical candidates. Results: Tables 1-3 show demographics, procedural characteristics, and outcomes. A comparison with routine PCI (British Cardiovascular Intervention Society data) and U.K. coronary bypass surgical data are listed if available and appropriate. There was significantly more prior myocardial infarction, PCI, and coronary artery bypass graft in the routine PCI database than in ReVasc Registry patients, suggesting more acute presentation in latter group. However, these were complex patients — mean SYNTAX score of 27.8 (range 9 to 65);and >20 times the number of LMS plus multivessel disease compared to the routine PCI group, with high use of adjunctive imaging. Radial use was high at 94.1%. PCI success was 97.0%. Complete revascularization was 52% and residual SYNTAX score 1.42 (0 to 20). The 2 deaths were acute, and mortality rate comparable to published surgical data. A 50% reduction in in-patient stay was observed. [Formula presented] Conclusion: In this multicenter U.K. registry, in-hospital outcomes with PCI for patients with complex coronary disease, normally treated with coronary artery bypass graft, compared well with surgical data suggesting the role of PCI could be extended. Future long-term follow-up is planned. Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)
ABSTRACT
Background: Coronavirus disease-2019 (COVID-19) poses a risk for health care workers necessitating modifications to existing medical pathways. In particular, managing patients with suspected COVID-19 represents a risk to the delivery of a primary percutaneous coronary intervention (PPCI) pathway where time-dependent revascularization is key. Methods: We sought to evaluate the effect of the COVID-19 pandemic on an established ambulance-triggered PPCI program involving 2 high-volume heart attack centers in London, United Kingdom. A systematic analysis was performed in patients with ST-segment elevation myocardial infarction undergoing PPCI comparing the COVID-19 pandemic period March 1, 2020, to April 30, 2020, with a control group from the previous year. Results: During the study period, admissions through the PPCI pathway decreased by 34%. The time from symptoms onset to first call for help (2020: 11 min vs. 2019: 12 min;p = 0.90) and from symptom onset to arrival at PPCI center (2020: 183 min vs. 2019: 178 min;p = 0.99) were comparable;however, the time from arrival at PPCI center to revascularization decreased (2020: 44 min vs. 2019: 53 min;p = 0.0004). In-hospital mortality during the study period was significantly lower (5% vs. 15%;p = 0.04). COVID-19–positive patients (n = 8) had higher rates of cardiogenic shock (25%), intensive care unit admission (50%), and inpatient mortality (38%). [Formula presented] Conclusion: Our data show that the modifications to the existing PPCI pathway were not associated with treatment delay or adverse outcome. The reduction in ST-segment elevation myocardial infarction presentations raises concern that patients may not be seeking appropriate medical attention for chest pain. Importantly, we demonstrate that PPCI can be delivered safely and efficiently during the COVID-19 pandemic. Categories: OTHER: COVID-19
ABSTRACT
Background: The demographics, angiographic findings, and in-hospital outcomes of coronavirus disease-2019 (COVID-19) – positive patients undergoing an invasive strategy for suspected acute coronary syndromes (ACS) are not well defined. COVID-19–positive ACS patients may have different etiology and outcomes. Patient presentation times from small sample published data appear longer. Methods: Anonymized data on 234 patients in 81 global centers are presented from this prospective registry for the period March 1, 2020, to May 31, 2020. As of submission date, a further 84 patients have been submitted. All were required to be COVID-19–positive (or have a high index of clinical suspicion, i.e., clinical status plus chest x ray/computed tomography scan findings) and to undergo coronary angiography for suspected ACS. Results: Results are shown in Tables 1–3 and compared with National United Kingdom British Cardiovascular Intervention Society/Myocardial Ischaemia National Audit Project databases of non–COVID-19 ACS patients where available and appropriate. Major findings were: significantly higher proportion of COVID-19–positive patients had hypertension, hyperlipidemia, and renal dysfunction. In the ST-segment elevation myocardial infarction (STEMI) subgroup, symptom-to-door time was >double and door-to-balloon increased by median 20 minutes. Mortality was quadruple and in-patient stay double in this group. Similarly, mortality was significantly higher in non-STEMI COVID-19–positive cohort and in-patient stay also double. The high mortality may be due to the high incidence of cardiogenic shock (13.4% vs. 5%), with its 67% mortality. [Formula presented] Conclusion: These novel data indicate that COVID-19–positive ACS patients present later, have higher incidence of cardiogenic shock, and much higher mortality, which are likely to be inter-related. In-patient stay is prolonged compared to non–COVID-19 ACS. Categories: CORONARY: Acute Coronary Syndromes