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1.
J Am Coll Cardiol ; 78(25): 2550-2560, 2021 12 21.
Article in English | MEDLINE | ID: covidwho-1549859

ABSTRACT

BACKGROUND: Regional heart attack services have improved clinical outcomes following ST-segment elevation myocardial infarction (STEMI) by facilitating early reperfusion by primary percutaneous coronary intervention (PCI). Early discharge after primary PCI is welcomed by patients and increases efficiency of health care. OBJECTIVES: This study aimed to assess the safety and feasibility of a novel early hospital discharge pathway for low-risk STEMI patients. METHODS: Between March 2020 and June 2021, 600 patients who were deemed at low risk for early major adverse cardiovascular events (MACE) were selected for inclusion in the pathway and were successfully discharged in <48 hours. Patients were reviewed by a structured telephone follow-up at 48 hours after discharge by a cardiac rehabilitation nurse and underwent a virtual follow-up at 2, 6, and 8 weeks and at 3 months. RESULTS: The median length of hospital stay was 24.6 hours (interquartile range [IQR]: 22.7-30.0 hours) (prepathway median: 65.9 hours [IQR: 48.1-120.2 hours]). After discharge, all patients were contacted, with none lost to follow-up. During median follow-up of 271 days (IQR: 88-318 days), there were 2 deaths (0.33%), both caused by coronavirus disease 2019 (>30 days after discharge), with 0% cardiovascular mortality and MACE rates of 1.2%. This finding compared favorably with a historical group of 700 patients meeting pathway criteria who remained in the hospital for >48 hours (>48-hour control group) (mortality, 0.7%; MACE, 1.9%) both in unadjusted and propensity-matched analyses. CONCLUSIONS: Selected low-risk patients can be discharged safely following successful primary PCI by using a pathway that is supported by a structured, multidisciplinary virtual follow-up schedule.


Subject(s)
Length of Stay/statistics & numerical data , Patient Discharge , Percutaneous Coronary Intervention/statistics & numerical data , ST Elevation Myocardial Infarction/surgery , Aged , COVID-19/prevention & control , Critical Pathways , Female , Humans , Male , Middle Aged , Prospective Studies
2.
Int Heart J ; 62(6): 1230-1234, 2021.
Article in English | MEDLINE | ID: covidwho-1542216

ABSTRACT

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with ST-elevation myocardial infarction (STEMI) should be treated as possibly infected individuals. Therefore, more time is considered necessary to conduct primary percutaneous coronary intervention (PCI). In this study, we sought to evaluate the impact of the SARS-CoV-2 pandemic on primary PCI for STEMI. Between March 2019 and March 2021, 259 patients with STEMI underwent primary PCI. Patients were divided into 2 groups: the pre-pandemic group (March 2019-February 2020) and the pandemic group (March 2020-February 2021). The patient demographics, reperfusion time including onset-to-door time, door-to-balloon time (DTBT), computed tomography (CT), peak creatinine phosphokinase (CPK), and 30-day mortality rate were investigated. The mean age of the patients was 70.4 ± 12.9 years, and 71.6% were male. There were 117 patients before the pandemic and 142 during the pandemic. The median DTBT was 29 (21.25-41.25) minutes before the pandemic and 48 minutes (31-73 minutes) during the pandemic (P < 0.001). The median door-to-catheter-laboratory time was 13.5 (10-18.75) minutes before the pandemic and 29.5 (18-47.25) minutes during the pandemic (P < 0.001). CT evaluation was performed before PCI in 39 (33.3%) patients and 63 (44.4%) patients (P = 0.08); their peak CPK levels were 1480 (358-2737.5) IU and 1363 (621-2722.75) IU (P = 0.56), and the 30-day mortality rates were 4.3% and 2.1% (P = 0.48), respectively. The SARS-CoV-2 pandemic changed the diagnostic procedure in the emergency department and affected the DTBT in patients with STEMI. Nonetheless, no adverse effects on the 30-day mortality rate were observed.


Subject(s)
COVID-19/complications , Creatine Kinase/blood , Percutaneous Coronary Intervention/statistics & numerical data , ST Elevation Myocardial Infarction/surgery , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Female , Health Impact Assessment/statistics & numerical data , Humans , Japan/epidemiology , Male , Middle Aged , Mortality/trends , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/mortality , Retrospective Studies , SARS-CoV-2/genetics , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/virology , Time Factors , Time-to-Treatment/trends
3.
Am J Emerg Med ; 53: 68-72, 2022 03.
Article in English | MEDLINE | ID: covidwho-1530556

ABSTRACT

OBJECTIVE: Strict control measures under the COVID epidemic have brought an inevitable impact on ST-segment elevation myocardial infarction (STEMI)'s emergency treatment. We investigated the impact of the COVID on the treatment of patients with STEMI undergoing primary PCI. METHODS: In this single center cohort study, we selected a time frame of 6 month after declaration of COVID-19 infection (Jan 24-July 24, 2020); a group of STEMI patients in the same period of 2019 was used as control. Finally, a total of 246 STEMI patients, who were underwent primary PCI, were enrolled into the study (136 non COVID-19 outbreak periods and 110 COVID-19 outbreak periods). The impact of COVID on the time of symptom onset to the first medical contact (symptom-to-FMC) and door to balloon (D-to-B) was investigated. Moreover, the primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, heart failure and malignant arrhythmia. RESULTS: Compared with the same period in 2019, there was a 19% decrease in the total number of STEMI patients undergoing primary PCI at the peak of the pandemic in 2020. The delay in symptom-to-FMC was significantly longer in COVID Outbreak period (180 [68.75, 342] vs 120 [60,240] min, P = 0.003), and the D-to-B times increased significantly (148 [115-190] vs 84 [70-120] min, P < 0.001). However, among patients with STEMI, MACE was similar in both time periods (18.3% vs 25.7%, p = 0.168). On multivariable analysis, COVID was not independently associated with MACE; the history of diabetes, left main disease and age>65 years were the strongest predictors of MACE in the overall population. CONCLUSIONS: The COVID pandemic was not independently associated with MACE; suggesting that active primary PCI treatment preserved high-quality standards even when challenged by a severe epidemic. CLINICAL TRIAL REGISTRATION: URL: https://ClinicalTrials.gov Unique identifier: NCT04427735.


Subject(s)
COVID-19/prevention & control , Percutaneous Coronary Intervention/statistics & numerical data , ST Elevation Myocardial Infarction/therapy , Aged , Beijing/epidemiology , COVID-19/complications , COVID-19/transmission , Cohort Studies , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention/trends , Retrospective Studies , ST Elevation Myocardial Infarction/epidemiology , Time Factors , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data , Treatment Outcome
4.
Can J Cardiol ; 37(10): 1547-1554, 2021 10.
Article in English | MEDLINE | ID: covidwho-1439940

ABSTRACT

BACKGROUND: The novel SARS-CoV-2 (COVID-19) pandemic has dramatically altered the delivery of healthcare services, resulting in significant referral pattern changes, delayed presentations, and procedural delays. Our objective was to determine the effect of the COVID-19 pandemic on all-cause mortality in patients awaiting commonly performed cardiac procedures. METHODS: Clinical and administrative data sets were linked to identify all adults referred for: (1) percutaneous coronary intervention; (2) coronary artery bypass grafting; (3) valve surgery; and (4) transcatheter aortic valve implantation, from January 2014 to September 2020 in Ontario, Canada. Piece-wise regression models were used to determine the effect of the COVID-19 pandemic on referrals and procedural volume. Multivariable Cox proportional hazards models were used to determine the effect of the pandemic on waitlist mortality for the 4 procedures. RESULTS: We included 584,341 patients who were first-time referrals for 1 of the 4 procedures, of whom 37,718 (6.4%) were referred during the pandemic. The pandemic period was associated with a significant decline in the number of referrals and procedures completed compared with the prepandemic period. Referral during the pandemic period was a significant predictor for increased all-cause mortality for the percutaneous coronary intervention (hazard ratio, 1.83; 95% confidence interval, 1.47-2.27) and coronary artery bypass grafting (hazard ratio, 1.96; 95% confidence interval, 1.28-3.01), but not for surgical valve or transcatheter aortic valve implantation referrals. Procedural wait times were shorter during the pandemic period compared with the prepandemic period. CONCLUSIONS: There was a significant decrease in referrals and procedures completed for cardiac procedures during the pandemic period. Referral during the pandemic was associated with increased all-cause mortality while awaiting coronary revascularization.


Subject(s)
COVID-19 , Cardiovascular Diseases , Coronary Artery Bypass/statistics & numerical data , Delayed Diagnosis , Percutaneous Coronary Intervention/statistics & numerical data , Transcatheter Aortic Valve Replacement/statistics & numerical data , Waiting Lists/mortality , COVID-19/epidemiology , COVID-19/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cardiovascular Diseases/psychology , Cardiovascular Diseases/surgery , Delayed Diagnosis/psychology , Delayed Diagnosis/statistics & numerical data , Delivery of Health Care/statistics & numerical data , Female , Humans , Infection Control/methods , Male , Middle Aged , Mortality , Ontario/epidemiology , SARS-CoV-2 , Time-to-Treatment/organization & administration
5.
Can J Cardiol ; 37(9): 1450-1459, 2021 09.
Article in English | MEDLINE | ID: covidwho-1397231

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. In this review we examine the global effect of the COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door to balloon time (D2B), all-cause mortality, and other secondary STEMI outcomes. METHODS: We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies that compared the aforementioned outcomes of STEMI patients during and before the pandemic. RESULTS: In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic, respectively. Significant delay in D2B was observed during the pandemic (weighted mean difference, 8.10 minutes; 95% confidence interval [CI], 3.90-12.30 minutes; P = 0.0002; I2 = 90%). In-hospital mortality was higher during the pandemic (odds ratio [OR], 1.27; 95% CI, 1.09-1.49; P = 0.002; I2 = 36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis showed that low-middle-income countries observed a higher rate of mortality during the pandemic (OR, 1.52; 95% CI, 1.13-2.05; P = 0.006), with a similar but insignificant trend seen among the high income countries (OR, 1.17; 95% CI, 0.95-1.44; P = 0.13). CONCLUSIONS: The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle-income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.


Subject(s)
COVID-19 , Pandemics , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/therapy , COVID-19/epidemiology , Databases, Factual , Hospital Mortality , Humans , Internationality , Pandemics/statistics & numerical data , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/mortality , Time Factors , Time-to-Treatment/statistics & numerical data , Treatment Outcome
6.
PLoS One ; 15(10): e0241149, 2020.
Article in English | MEDLINE | ID: covidwho-1388891

ABSTRACT

INTRODUCTION: Early reports described decreased admissions for acute cardiovascular events during the SarsCoV-2 pandemic. We aimed to explore whether the lockdown enforced during the SARSCoV-2 pandemic in Israel impacted the characteristics of presentation, reperfusion times, and early outcomes of ST-elevation myocardial infarction (STEMI) patients. METHODS: A multicenter prospective cohort comprising all STEMI patients treated by primary percutaneous coronary intervention admitted to four high-volume cardiac centers in Israel during lockdown (20/3/2020-30/4/2020). STEMI patients treated during the same period in 2019 served as controls. RESULTS: The study comprised 243 patients, 107 during the lockdown period of 2020 and 136 during the same period in 2019, with no difference in demographics and clinical characteristics. Patients admitted in 2020 had higher admission and peak troponin levels, had a 2.4 fold greater likelihood of Door-to-balloon times> 90 min (95%CI: 1.2-4.9, p = 0.01) and 3.3 fold greater likelihood of pain-to-balloon times> 12 hours (OR 3.3, 95%CI: 1.3-8.1, p<0.01). They experienced higher rates hemodynamic instability (25.2% vs 14.7%, p = 0.04), longer hospital stay (median, IQR [4, 3-6 Vs 5, 4-6, p = 0.03]), and fewer early (<72 hours) discharge (12.4% Vs 32.4%, p<0.001). CONCLUSIONS: The lockdown imposed during the SARSCoV-2 pandemic was associated with a significant lag in the time to reperfusion of STEMI patients. Measures to improves this metric should be implemented during future lockdowns.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/standards , Patient Admission/statistics & numerical data , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Female , Humans , Israel/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Pandemics/prevention & control , Patient Admission/standards , Patient Discharge/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Prospective Studies , Registries/statistics & numerical data , SARS-CoV-2/pathogenicity , ST Elevation Myocardial Infarction/diagnosis , Time Factors , Treatment Outcome
7.
Am J Cardiol ; 157: 42-47, 2021 10 15.
Article in English | MEDLINE | ID: covidwho-1356116

ABSTRACT

Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the "Early Phase" of the pandemic (March 1 - June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the "Later Phase" of the pandemic (October 1, 2020 - January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the "Early Phase" and 621 during the "Later Phase." Maximum troponin-I in the "Early Phase" was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the "Later Phase" (p = 0.553). In-hospital mortality was significantly higher in the "Later Phase" (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more "Early Phase" patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of "Early Phase" and 0.8% of "Later Phase" patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.


Subject(s)
COVID-19/epidemiology , Myocardial Infarction/therapy , Troponin I/blood , Aged , Aged, 80 and over , Clinical Competence , Cohort Studies , Coronary Angiography/statistics & numerical data , District of Columbia/epidemiology , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Maryland/epidemiology , Middle Aged , Myocardial Infarction/epidemiology , Pandemics , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Respiration, Artificial/statistics & numerical data
8.
Am Heart J ; 241: 14-25, 2021 11.
Article in English | MEDLINE | ID: covidwho-1283847

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disrupted routine cardiovascular care, with unclear impact on procedural deferrals and associated outcomes across diverse patient populations. METHODS: Cardiovascular procedures performed at 30 hospitals across 6 Western states in 2 large, non-profit healthcare systems (Providence St. Joseph Health and Stanford Healthcare) from December 2018-June 2020 were analyzed for changes over time. Risk-adjusted in-hospital mortality was compared across pandemic phases with multivariate logistic regression. RESULTS: Among 36,125 procedures (69% percutaneous coronary intervention, 13% coronary artery bypass graft surgery, 10% transcatheter aortic valve replacement, and 8% surgical aortic valve replacement), weekly volumes changed in 2 distinct phases after the initial inflection point on February 23, 2020: an initial period of significant deferral (COVID I: March 15-April 11) followed by recovery (COVID II: April 12 onwards). Compared to pre-COVID, COVID I patients were less likely to be female (P = .0003), older (P < .0001), Asian or Black (P = .02), or Medicare insured (P < .0001), and COVID I procedures were higher acuity (P < .0001), but not higher complexity. In COVID II, there was a trend toward more procedural deferral in regions with a higher COVID-19 burden (P = .05). Compared to pre-COVID, there were no differences in risk-adjusted in-hospital mortality during both COVID phases. CONCLUSIONS: Significant decreases in cardiovascular procedural volumes occurred early in the COVID-19 pandemic, with disproportionate impacts by race, gender, and age. These findings should inform our approach to future healthcare disruptions.


Subject(s)
Aortic Valve Disease/surgery , COVID-19/epidemiology , Coronary Artery Bypass/statistics & numerical data , Coronary Artery Disease/surgery , Hospital Mortality , Percutaneous Coronary Intervention/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Transcatheter Aortic Valve Replacement/statistics & numerical data , African Americans , Aged , Asian Americans , Female , Heart Valve Prosthesis Implantation/statistics & numerical data , Humans , Logistic Models , Male , Medicare , Middle Aged , SARS-CoV-2 , Sex Factors , United States/epidemiology
9.
J Am Coll Cardiol ; 77(16): 1994-2003, 2021 04 27.
Article in English | MEDLINE | ID: covidwho-1188684

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). OBJECTIVES: The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. METHODS: A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. RESULTS: As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). CONCLUSIONS: COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.


Subject(s)
COVID-19/epidemiology , Percutaneous Coronary Intervention/statistics & numerical data , SARS-CoV-2 , ST Elevation Myocardial Infarction/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Canada/epidemiology , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , North America/epidemiology , Prospective Studies , Recurrence , Registries/statistics & numerical data , Reoperation/statistics & numerical data , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Stroke/epidemiology , Stroke/etiology , United States/epidemiology , Young Adult
10.
Arch Cardiovasc Dis ; 114(5): 340-351, 2021 May.
Article in English | MEDLINE | ID: covidwho-1184770

ABSTRACT

BACKGROUND: Systems of care have been challenged to control progression of the COVID-19 pandemic. Whether this has been associated with delayed reperfusion and worse outcomes in French patients with ST-segment elevation myocardial infarction (STEMI) is unknown. AIM: To compare the rate of STEMI admissions, treatment delays, and outcomes between the first peak of the COVID-19 pandemic in France and the equivalent period in 2019. METHODS: In this nationwide French survey, data from consecutive STEMI patients from 65 centres referred for urgent revascularization between 1 March and 31 May 2020, and between 1 March and 31 May 2019, were analysed. The primary outcome was a composite of in-hospital death or non-fatal mechanical complications of acute myocardial infarction. RESULTS: A total of 6306 patients were included. During the pandemic peak, a 13.9±6.6% (P=0.003) decrease in STEMI admissions per week was observed. Delays between symptom onset and percutaneous coronary intervention were longer in 2020 versus 2019 (270 [interquartile range 150-705] vs 245 [140-646]min; P=0.013), driven by the increase in time from symptom onset to first medical contact (121 [60-360] vs 150 [62-420]min; P=0.002). During 2020, a greater number of mechanical complications was observed (0.9% vs 1.7%; P=0.029) leading to a significant difference in the primary outcome (112 patients [5.6%] in 2019 vs 129 [7.6%] in 2020; P=0.018). No significant difference was observed in rates of orotracheal intubation, in-hospital cardiac arrest, ventricular arrhythmias and cardiogenic shock. CONCLUSIONS: During the first peak of the COVID-19 pandemic in France, there was a decrease in STEMI admissions, associated with longer ischaemic time, exclusively driven by an increase in patient-related delays and an increase in mechanical complications. These findings suggest the need to encourage the population to seek medical help in case of symptoms.


Subject(s)
COVID-19/epidemiology , Pandemics , ST Elevation Myocardial Infarction/therapy , Comorbidity , Diabetes Mellitus/epidemiology , Female , France/epidemiology , Health Care Surveys , Heart Rupture, Post-Infarction/epidemiology , Hospital Mortality , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care , Patient Admission/statistics & numerical data , Percutaneous Coronary Intervention/statistics & numerical data , Procedures and Techniques Utilization , Prognosis , Risk Factors , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/epidemiology , Smoking/epidemiology , Stents , Time-to-Treatment , Treatment Outcome
11.
BMJ Open ; 11(4): e045590, 2021 04 02.
Article in English | MEDLINE | ID: covidwho-1166507

ABSTRACT

AIMS: To evaluate temporal trends of acute coronary syndromes (ACS) treated via percutaneous coronary intervention (PCI) throughout the COVID-19 outbreak in a European healthcare system affected but not overwhelmed by COVID-19-related pathology. METHODS AND RESULTS: We performed a retrospective multicentre analysis of the rates of PCI for the treatment of ACS within the period 2 months pre and post the first confirmed COVID-19 case in Ireland, as well as comparing PCI for ST-elevation myocardial infarction (STEMI) with the corresponding period in 2019. During the 2020 COVID-19 period (29 February-30 April 2020), there was a 24% decline in PCI for overall ACS (incidence rate ratio (IRR) 0.76; 95% CI 0.65 to 0.88; p<0.001), including a 29% reduction in PCI for non-ST-elevation ACS (IRR 0.71; 95% CI 0.57 to 0.88; p=0.002) and an 18% reduction in PCI for STEMI (IRR 0.82; 95% CI 0.67 to 1.01; p=0.061), as compared with the 2020 pre-COVID-19 period (1 January-28 February 2020). A 22% (IRR 0.78; 95% CI 0.65 to 0.93; p=0.005) reduction of PCI for STEMI was seen as compared with the 2019 reference period. CONCLUSION: This study demonstrates a significant reduction in PCI procedures for the treatment of ACS since the COVID-19 outbreak in Ireland. The reasons for this decline are still unclear but patients need to be encouraged to seek medical attention when cardiac symptoms appear, in order to avoid incremental cardiac morbidity and mortality due to a reduction in coronary revascularisation for the treatment of ACS.


Subject(s)
Acute Coronary Syndrome , COVID-19/epidemiology , Percutaneous Coronary Intervention/statistics & numerical data , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/surgery , Delivery of Health Care , Humans , Ireland/epidemiology , Pandemics , Retrospective Studies , Treatment Outcome
12.
Swiss Med Wkly ; 150: w20448, 2020 12 14.
Article in English | MEDLINE | ID: covidwho-1004917

ABSTRACT

AIM: To assess the impact of the first wave of the COVID-19 pandemic on acute coronary syndromes and on the delay from symptom onset to first medical contact among patients presenting with ST-segment elevation myocardial infarction (STEMI), as well as to investigate whether there were patient-related reasons related to COVID-19 for delaying first medical contact. METHODS AND RESULTS: All patients undergoing percutaneous coronary intervention (PCI) at the Geneva University Hospitals for acute coronary syndromes (ACS) during the first COVID-19 wave were compared with a control group consisting of all ACS patients who underwent PCI during the same period in 2019 and those treated in the period immediately preceding the pandemic. The primary outcome measure was the difference in the delay from symptom onset to first medical contact in the setting of STEMI between the COVID-19 period and the control period. Secondary outcome measures were the difference in ACS incidence and the impact of the COVID-19 pandemic on patients’ decisions to call the emergency services, assessed using a questionnaire. Delay from symptom onset to first medical contact was longer among patients suffering from STEMI in the COVID-19 period compared with the control period (112 min vs 60 min, p = 0.049). The incidence rate of ACS was lower during the COVID-19 period (incidence rate ratio 0.6, 95% confidence interval [CI] 0.449–0.905). ACS patients delayed their call to the emergency services mainly because of fear of contracting or spreading COVID-19 following hospital admission, as well as of adding burden to the healthcare system. CONCLUSION: We observed prolonged delays from symptom onset to first medical contact and a decline in overall ACS incidence during the first wave of the COVID-19 pandemic, with a higher threshold to call for help among ACS patients.


Subject(s)
Acute Coronary Syndrome/epidemiology , COVID-19/epidemiology , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/therapy , Time-to-Treatment/statistics & numerical data , Acute Coronary Syndrome/surgery , Aged , Comorbidity , Female , Humans , Length of Stay , Male , Middle Aged , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Pandemics , Percutaneous Coronary Intervention/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Troponin/blood
14.
J Am Coll Cardiol ; 76(20): 2321-2330, 2020 11 17.
Article in English | MEDLINE | ID: covidwho-912307

ABSTRACT

BACKGROUND: The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality. OBJECTIVES: The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of "at-risk" patient cohorts for failure to present or delays to treatment. METHODS: This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality. RESULTS: A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic. CONCLUSIONS: The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).


Subject(s)
Coronavirus Infections , Pandemics , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral , Registries , ST Elevation Myocardial Infarction/mortality , Aged , COVID-19 , Europe/epidemiology , Female , Humans , Male , Middle Aged , Retrospective Studies , ST Elevation Myocardial Infarction/therapy
15.
Circ Cardiovasc Interv ; 13(11): e009654, 2020 11.
Article in English | MEDLINE | ID: covidwho-901506

ABSTRACT

BACKGROUND: The objective of the study was to evaluate changes in percutaneous coronary intervention (PCI) practice in England by analyzing procedural numbers, changes in the clinical presentation, and characteristics of patients and their clinical outcomes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study of all patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society database. RESULTS: Forty-four hospitals reported PCI procedures for 126 491 patients. There were ≈700 procedures performed each week before the lockdown. After the March 23, 2020 lockdown (11th/12th week in 2020), there was a 49% fall in the number of PCI procedures after the 12th week in 2020. The decrease was greatest in PCI procedures performed for stable angina (66%), followed by non-ST-segment-elevation myocardial infarction (45%), and ST-segment-elevation myocardial infarction (33%). Patients after the lockdown were younger (64.5 versus 65.5 years, P<0.001) and less likely to have diabetes (20.4% versus 24.6%, P<0.001), hypertension (52.0% versus 56.8%, P=0.001), previous myocardial infarction (23.5% versus 26.7%, P=0.008), previous PCI (24.3% versus 28.3%, P=0.001), or previous coronary artery bypass graft (4.6% versus 7.2%, P<0.001) compared with before the lockdown. CONCLUSIONS: The lockdown in England has resulted in a significant decline in PCI procedures. Fewer patients underwent PCI for stable angina. This enabled greater capacity for urgent and emergency cases, and a reduced length of stay was seen for such patients. Significant changes in the characteristics of patients towards a lower risk phenotype were observed, particularly for non-ST-segment-elevation myocardial infarction, reflecting a more conservative approach to this cohort.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Angina Pectoris/therapy , COVID-19 , England , Female , Humans , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/therapy , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
16.
Anatol J Cardiol ; 24(5): 334-342, 2020 11.
Article in English | MEDLINE | ID: covidwho-895744

ABSTRACT

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).


Subject(s)
Coronavirus Infections/epidemiology , Myocardial Infarction/therapy , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Time-to-Treatment/statistics & numerical data , Aged , COVID-19 , Coronary Angiography/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Female , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Percutaneous Coronary Intervention/statistics & numerical data , Prognosis , Registries , Regression Analysis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Time Factors , Treatment Outcome , Turkey/epidemiology
17.
Turk Kardiyol Dern Ars ; 48(7): 640-645, 2020 10.
Article in English | MEDLINE | ID: covidwho-841619

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused by the emergence of severe acute respiratory syndrome coronavirus 2 has resulted in a health crisis and a significant number of deaths worldwide. The full effect on access to medical care and the treatment for patients with chronic diseases and acute conditions is still unknown. This is an investigation of access to primary percutaneous coronary intervention (PPCI) for patients diagnosed with ST-segment myocardial infarction (STEMI) during the pandemic. METHODS: Consecutive patients who were diagnosed with STEMI and underwent PPCI during the ongoing COVID-19 pandemic were included in the study. Clinical and angiographic characteristics of the patients were assessed. A control group of patients diagnosed with STEMI and who underwent PPCI during the same time interval a year prior to the outbreak of the disease was analyzed retrospectively for comparison. RESULTS: There was a significant reduction in the number of STEMI cases during the COVID-19 crisis period. Furthermore, these patients had a prolonged ischemic time; they were more likely to have a longer pain-to-balloon (Odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.1-10.2) and door-to-balloon time (OR: 5.4, 95% CI: 3.1-22.8). CONCLUSION: Patients diagnosed with STEMI during the pandemic experienced a significant delay between the onset of symptoms and PPCI.


Subject(s)
Coronavirus Infections , Health Services Accessibility/statistics & numerical data , Pandemics , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/surgery , Aged , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
18.
Heart ; 106(23): 1812-1818, 2020 12.
Article in English | MEDLINE | ID: covidwho-835510

ABSTRACT

OBJECTIVE: Most reports on the declining incidence of myocardial infarction (MI) during the COVID-19 have either been anecdotal, survey results or geographically limited to areas with lockdowns. We examined the incidence of MI during the COVID-19 pandemic in Sweden, which has remained an open society with a different public health approach fighting COVID-19. METHODS: We assessed the incidence rate (IR) as well as the incidence rate ratios (IRRs) of all MI referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR), during the COVID-19 pandemic in Sweden (1 March 2020-7 May 2020) in relation to the same days 2015-2019. RESULTS: A total of 2443 MIs were referred for coronary angiography during the COVID-19 pandemic resulting in an IR 36 MIs/day (204 MIs/100 000 per year) compared with 15 213 MIs during the reference period with an IR of 45 MIs/day (254 MIs/100 000 per year) resulting in IRR of 0.80, 95% CI (0.74 to 0.86), p<0.001. Results were consistent in all investigated patient subgroups, indicating no change in patient category seeking cardiac care. Kaplan-Meier event rates for 7-day case fatality were 439 (2.3%) compared with 37 (2.9%) (HR: 0.81, 95% CI (0.58 to 1.13), p=0.21). Time to percutaneous coronary intervention (PCI) was shorter during the pandemic and PCI was equally performed, indicating no change in quality of care during the pandemic. CONCLUSION: The COVID-19 pandemic has significantly reduced the incidence of MI referred for invasive treatment strategy. No differences in overall short-term case fatality or quality of care indicators were observed.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Myocardial Infarction/epidemiology , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Aged , COVID-19 , Communicable Disease Control , Coronary Angiography , Coronavirus Infections/prevention & control , Female , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/surgery , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Registries , SARS-CoV-2 , Sweden , Time-to-Treatment
19.
J Cardiovasc Med (Hagerstown) ; 21(11): 869-873, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-810031

ABSTRACT

AIMS: The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. MATERIALS AND METHODS: Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. RESULTS: We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (-5.6%) and non-ST-elevation myocardial infarction (-34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (-25% for STEMI and -70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). CONCLUSION: During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.


Subject(s)
Acute Coronary Syndrome , Coronavirus Infections , Hospitalization/statistics & numerical data , Myocardial Infarction , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delayed Diagnosis/statistics & numerical data , Female , Hospital Mortality , Humans , Infection Control/methods , Italy/epidemiology , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Myocardial Infarction/surgery , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data
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