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Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction.
Kwok, Chun Shing; Gale, Chris P; Kinnaird, Tim; Curzen, Nick; Ludman, Peter; Kontopantelis, Evan; Wu, Jianhua; Denwood, Tom; Fazal, Nadeem; Deanfield, John; de Belder, Mark A; Mamas, Mamas.
  • Kwok CS; Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK.
  • Gale CP; Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
  • Kinnaird T; Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK.
  • Curzen N; Department of Cardiology, University Hospital of Wales, Cardiff, UK.
  • Ludman P; Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  • Kontopantelis E; Institute of Cardiovascular Sciences, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
  • Wu J; Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK.
  • Denwood T; Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK.
  • Fazal N; Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK.
  • Deanfield J; NHS Digital, Leeds, UK.
  • de Belder MA; National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.
  • Mamas M; National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK.
Heart ; 106(23): 1805-1811, 2020 12.
Article in English | MEDLINE | ID: covidwho-738353
ABSTRACT

BACKGROUND:

The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.

METHODS:

We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.

RESULTS:

A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99-270) vs 135 (89-250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21-112) vs 37 (16-94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).

CONCLUSIONS:

Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Communicable Disease Control / Coronavirus Infections / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Heart Journal subject: Cardiology Year: 2020 Document Type: Article Affiliation country: Heartjnl-2020-317650

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Communicable Disease Control / Coronavirus Infections / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction / Betacoronavirus Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Heart Journal subject: Cardiology Year: 2020 Document Type: Article Affiliation country: Heartjnl-2020-317650