Impact of the COVID-19 pandemic on catheterization laboratory procedural volumes at a tertiary cardiac centre in a low- & middle-income country in South Asia

ABSTRACT

Background: Globally, reports have suggested that cardiac catheterization procedures, particularly elective coronary procedures declined as a result of the COVID-19 pandemic. However, there is scarce data on this aspect, in terms of a South Asian low- & middle-income country (LMIC) setting. Purpose: We aimed to evaluate temporal trends and impact of the pandemic on elective and emergency cardiac catheterization procedural volumes at a high-volume tertiary cardiac centre in a LMIC. Methods: Data on both emergency and elective catheterization procedures, including coronary angiography, percutaneous coronary intervention (PCI), peripheral angiography, pacing & electrophysiology (EP) were collected from January to December 2020, and compared with corresponding data for the same months in 2019. Data were obtained from hospital's catheterization laboratory database. The difference was expressed as a percentage (%Δ). Data for each quarter were compared using paired ttest. A p value <0.05 was considered significant. Results: Overall, a significant (32.4%) reduction of cath lab procedures was seen in 2020, as compared with 2019 (p=0.006). There were significantly reduced numbers of coronary angiographies (%Δ -31.4%;p=0.009), PCI (%Δ -32.2%;p=0.008), peripheral procedures (%Δ -69.9%;p=0.001) and pacing & EP procedures (Δ--48.7%;p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). For coronary procedures this was most marked in 2nd and 3rd quarters of 2020 (p<0.05). The greatest deficits for coronary angiographies were observed in April 2020, compared to 2019 (Δ -85.1%);the greatest reductions in PCI (Δ- 87.7%) and pacing & EP (Δ -94.7%) were seen in May 2020, coinciding with the nation-wide lockdown measures. Coronary procedures showed a gradually increasing trend since July 2020. Given their elective nature, no peripheral procedures were performed from April to July 2020. In terms of PCI, there was a significant reduction in elective procedures in the 2nd quarter of 2020 (p=0.001), with a steep catch-up incline in September (Δ +2.9%) and October 2020 (Δ -8.3%), coinciding with availability of inhospital COVID19 screening tests (Table 1). Among ad hoc PCI for acute coronary syndrome (ACS), although a 32.3% reduction was seen overall (p=0.108), a significant decrease was only observed in the 2nd quarter. Ad hoc PCI for non-ACS was significantly reduced throughout 2nd to 4th quarters of 2020. In line with national guidelines preferring fibrinolysis as first-line for STEMI, as well as absence of negative pressure ventilation cath labs and unavailability of rapid-screening COVID test kits, no primary PCI procedures were performed since May 2020. Conclusion: The impact of COVID-19 resulted in a significant reduction in all cardiac catheterization procedures in 2020, as compared with 2019. This reduction was most marked for coronary procedures in the 2nd and 3rd quarters of 2020, with a significant reduction in elective procedures.