ABSTRACT
Background: Delayed door-to-balloon (DTB) time and deterioration of inhospital mortality during the coronavirus disease 2019 (COVID-19) pandemic have been reported. Little is known about the impact of changes in in-hospital medical management before primary percutaneous coronary intervention (PCI) for COVID-19 such as screening test (antigen or polymerase chain reaction (PCR) tests, chest CT for excluding the pneumoniae) and primary PCI under full personal protective equipment (PPE) on DTB time and in-hospital mortality. Purpose(s): The purpose of this study was to evaluate the impact of inhospital medical management for COVID-19 on DTB time and in-hospital mortality during COVID-19 pandemic period. Method(s): We compared DTB time and in-hospital mortality of 502 STelevation myocardial infarction (STEMI) patients during COVID-19 pandemic (February 2020 and January 2021) with 2035 STEMI patients before pandemic (February 2016 and January 2020) using date from Mie ACS registry, a retrospective and multicenter registry. Result(s): The COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was performed on 173/502 (34.5%) patients (antigen or PCR tests;39 (7.8%), chest CT;156 (31.3%), full PPE;11 (2.2%)). These patients had lower rate of achievement of DTB time <=90 min compared with others (Figure 1A). Moreover, In-hospital management of COVID-19 screening tests and/or primary PCI under full PPE was an independent factor of DTB time>90 min with odds ratio of 1.94 (95% confidential interval: 1.37-2.76, p<0.001). In addition, in-hospital mortality of those patients was higher compared with others (Figure 1B). Conclusion(s): In-hospital medical management for COVID-19 screening tests before primary PCI and/or primary PCI under full PPE was the independent factor of DTB time>90 min. This study reinforces the need to focus efforts on shortening DTB time, while controlling the epidemic of infection.
ABSTRACT
Background: An emergency framework was set to confront the first wave COVID-19 pandemic at the medical oncology division for breast cancer at the Cancer Institute Hospital of JFCR, Tokyo, in March 2020. Medical therapy was classified into two phases in our guideline. In the initial phase, workload or patients' visit was to be reduced without impairing disease control and survival. In the successive phase under restriction of medical resources, only therapies with higher priority and alternate therapies were to be practiced. Whereas no significant effect on medical practice was observed during first wave pandemic, actual impact was evaluated in this study. Methods: Among patients in our division from April to May 2020, cases of treatment change, postponement of treatment introduction, treatment interruption, long-term prescription, telephone consultation, postponement of visit, reference to other hospital, and COVID-19 diagnosis were retrospectively searched from medical records. Results: There were estimated 984 patients, 389 perioperative and 595 metastatic, of whom 119(12%) were affected by COVID-19. The breakdown is 7 cases of treatment changes, 7 cases of postponements of introduction, 20 cases of interruptions, 12 cases of long-term prescriptions of oral chemotherapy and molecular targeted therapy, 36 cases of prescriptions by telephone consultation, 94 cases of postponements of visit, 3 cases of reference to other hospital, and 4 cases of fever for which COVID-19 infection could not be denied. Conclusion: 12% of patients in the division of medical oncology at the breast center changed their treatment or schedule of visit. Treatment change that could affect breast cancer survival were 2 cases of cancellation of adjuvant chemotherapy. The effect might have been minimized by formulation of a COVID-19 guideline prior to the pandemic.