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Impact of COVID-19 pandemic on the management of nonculprit lesions in patients presenting with ST-elevation myocardial infarction: Outcomes from the pan-London heart attack centers.
Demir, Ozan M; Little, Callum D; Jabbour, Richard; Rahman, Haseeb; Sayers, Max; Ahmed, Asrar; Connolly, Michelle J; Kanyal, Ritesh; MacCarthy, Philip; Wilson, Simon J; Dalby, Miles; Jain, Ajay; Malik, Iqbal; Rakhit, Roby; Perera, Divaka.
  • Demir OM; NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
  • Little CD; Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK.
  • Jabbour R; Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK.
  • Rahman H; Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK.
  • Sayers M; Department of Cardiology, Barts Health NHS Trust, London, UK.
  • Ahmed A; Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
  • Connolly MJ; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Kanyal R; Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.
  • MacCarthy P; Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK.
  • Wilson SJ; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK.
  • Dalby M; Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
  • Jain A; Department of Cardiology, Barts Health NHS Trust, London, UK.
  • Malik I; Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, London, UK.
  • Rakhit R; Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK.
  • Perera D; NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK.
Catheter Cardiovasc Interv ; 99(2): 391-396, 2022 02.
Article in English | MEDLINE | ID: covidwho-1589160
ABSTRACT

BACKGROUND:

The impact of COVID-19 on the diagnosis and management of nonculprit lesions remains unclear.

OBJECTIVES:

This study sought to evaluate the management and outcomes of patients with nonculprit lesions during the COVID-19 pandemic.

METHODS:

We conducted a retrospective observational analysis of consecutive primary percutaneous coronary intervention (PPCI) pathway activations across the heart attack center network in London, UK. Data from the study period in 2020 were compared with prepandemic data in 2019. The primary outcome was the rate of nonculprit lesion percutaneous coronary intervention (PCI) and secondary outcomes included major adverse cardiovascular events.

RESULTS:

A total of 788 patients undergoing PPCI were identified, 209 (60%) in 2020 cohort and 263 (60%) in 2019 cohort had nonculprit lesions (p = .89). There was less functional assessment of the significance of nonculprit lesions in the 2020 cohort compared to 2019 cohort; in 8% 2020 cohort versus 15% 2019 cohort (p = .01). There was no difference in rates of PCI for nonculprit disease in the 2019 and 2020 cohorts (31% vs 30%, p = .11). Patients in 2020 cohort underwent nonculprit lesion PCI sooner than the 2019 cohort (p < .001). At 6 months there was higher rates of unplanned revascularization (4% vs. 2%, p = .05) and repeat myocardial infarction (4% vs. 1%, p = .02) in the 2019 cohort compared to 2020 cohort.

CONCLUSION:

Changes to clinical practice during the COVID-19 pandemic were associated with reduced rates of unplanned revascularization and myocardial infarction at 6-months follow-up, and despite the pandemic, there was no difference in mortality, suggesting that it is not only safe but maybe more efficacious.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 / Myocardial Infarction Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal: Catheter Cardiovasc Interv Journal subject: Cardiology Year: 2022 Document Type: Article Affiliation country: Ccd.30056

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / COVID-19 / Myocardial Infarction Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: Europa Language: English Journal: Catheter Cardiovasc Interv Journal subject: Cardiology Year: 2022 Document Type: Article Affiliation country: Ccd.30056