ABSTRACT
Background: The COVID-19 pandemic had a significant impact on the quality of healthcare provision across all specialities and disciplines. However, there are limited data on the scale of its disruption to cardiac procedure activity from a national perspective and whether procedural outcomes different before and during the COVID-19 pandemic. Methods: Major cardiac procedures (n=374,899) performed between 1st January and 31st May for the years 2018, 2019 and 2020 were analysed, stratified by procedure type and time-period (pre-COVID: January-May 2018 and 2019 and January-February 2020 and COVID: March-May 2020). Multivariable logistic regression modelling was undertaken to examine the odds ratio (OR) of 30-day mortality for procedures performed in the COVID period (vs. pre-COVID). Results: There was a deficit of 45,501 procedures during the COVID period compared to the monthly averages (March-May) in 2018–2019. Cardiac catheterisation and cardiac electronic device implantations were the most affected in terms of numbers (n=19,637 and n=10,453) while surgical procedures including mitral valve replacement, other valve replacement/repair, atrial and ventricular septal defect repair, and CABG were the most affected as a relative percentage difference (D) to previous years' averages. TAVR was the least affected (D-10.6%). No difference in 30-day mortality was observed between pre-COVID and COVID time-periods for all cardiac procedures except cardiac catheterisation (OR 1.25 95% confidence interval (CI) 1.07–1.47, p=0.006) and cardiac device implantation (OR 1.35 95% CI 1.15–1.58, p<0.001). Conclusion: There was a significant decline in national cardiac procedural activity in England during the COVID-19 pandemic, with a deficit in excess of 45000 procedures over the study period. However, there was no increase in risk of mortality for most cardiac procedures performed during the pandemic. While health service pressures are gradually easing given the increased roll out of vaccination and decline in infection rates, there is a need for major restructuring of cardiac services deal with this significant backlog of procedures, which would inevitably impact longer-term morbidity and mortality. Funding Acknowledgement: Type of funding sources: None.Figure 1
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: 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