The impact of the Coronavirus disease 2019 on hospitalizations for coronary artery revascularization: results from California State Inpatient Database.

BACKGROUND: Coronavirus disease 2019 (COVID-19) outbreak has negatively impacted routine cardiovascular care. In this study, we assessed the impact of COVID-19 pandemic on percutaneous coronary artery intervention (PCI) and coronary artery bypass grafting (CABG) hospitalizations and outcomes using a large database. METHODS: The current study was a retrospective analysis of California State Inpatient Database (SID) during March-December of 2019 and 2020. All adult hospitalizations for coronary artery revascularization were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. The primary outcome was inhospital mortality, and secondary outcomes were hospital length of stay, stroke, acute kidney injury, and mechanical ventilation. Propensity score match analysis was done to compare adverse clinical outcomes. RESULTS: PCI hospitalizations (relative decrease, 15.0%, P for trend <0.001) and CABG hospitalizations (relative decrease, 16.4%, P for trend <0.001) decreased from 2019 to 2020, while viral pneumonia hospitalizations increased (relative increase, 1751.6%, P for trend <0.001). Monthly PCI and CABG hospitalization showed decreasing trends from January 2019 to December 2020. Propensity score match analysis showed that the odds of inhospital mortality (OR, 1.12; 95% CI, 1.01-1.24), acute kidney injury (OR, 1.12; 95% CI, 1.06-1.17), and ARDS (OR, 1.89; 95% CI, 1.18-3.01) were higher among patients who received PCI in 2020. CONCLUSION: Results of our study indicate that initiatives such as encouraging patients to receive treatments and controlling the spread of COVID-19 should be instituted to improve PCI and CABG hospitalizations.

Colchicine for the Treatment of Cardiac Injury in Hospitalized Patients With Coronavirus Disease-19.

Introduction: The impact of colchicine on hospitalized patients with Coronavirus disease-19 (COVID-19) related cardiac injury is unknown. Materials and Methods: In this multicenter randomized controlled open-label clinical trial, we randomized hospitalized adult patients with documented COVID-19 and evidence of cardiac injury in a 1:1 ratio to either colchicine 0.6 mg po twice daily for 30 days plus standard of care or standard of care alone. Cardiac injury was defined as elevated cardiac biomarkers, new arrhythmia, new/worsened left ventricular dysfunction, or new pericardial effusion. The primary endpoint was the composite of all-cause mortality, need for mechanical ventilation, or need for mechanical circulatory support (MCS) at 90 days. Key secondary endpoints included the individual components of the primary endpoint and change in and at least 2-grade reduction in the World Health Organization (WHO) Ordinal Scale at 30 days. The trial is registered with clinicaltrials.gov (NCT04355143). Results: We enrolled 93 patients, 48 patients in the colchicine arm and 45 in the control arm. There was no significant difference in the primary outcome between the colchicine and control arms (19 vs. 15%, p = 0.78), nor in the individual components of all-cause mortality (17 vs. 15%, p = 1.0) and need for mechanical ventilation (8 vs. 5%, p = 0.68); no patients in either group required MCS. The change in (-1.8 ± 2.4 vs. -1.2 ± 2.0, p = 0.12) and at least 2-grade reduction (75 vs. 75%, p = 1.0) in the WHO ordinal scale was also similar between groups. Conclusion: Patients hospitalized with COVID-19 and evidence of cardiac injury did not benefit from colchicine therapy.

Hospital Outcomes Among COVID-19 Hospitalizations With Myocarditis from the California State Inpatient Database.

Many case reports have indicated that myocarditis could be a prognostic factor for predicting morbidity and mortality among patients with COVID-19. In this study, using a large database we examined the association between myocarditis among COVID-19 hospitalizations and in-hospital mortality and other adverse hospital outcomes. The present study was a retrospective analysis of data collected in the California State Inpatient Database during 2020. All hospitalizations for COVID-19 were included in the analysis and grouped into those with and without myocarditis. The outcomes were in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome. Propensity score matching, followed by conditional logistic regression, was performed to find the association between myocarditis and outcomes. Among 164,417 COVID-19 hospitalizations, 578 (0.4%) were with myocarditis. After propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (30.0% vs 17.5%, p <0.001). Survival analysis with log-rank test showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% vs 46.3%, p <0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.16 to 3.14), cardiogenic shock (OR 4.13, 95% CI 2.14 to 7.99), mechanical ventilation (OR 3.30, 95% CI 2.47 to 4.41), and acute respiratory distress syndrome (OR 2.49, 95% CI 1.70 to 3.66) were significantly higher among those with myocarditis. Myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among patients with COVID-19, and early suspicion is important for prompt diagnosis and management.