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COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group.
Little, Callum D; Kotecha, Tushar; Candilio, Luciano; Jabbour, Richard J; Collins, George B; Ahmed, Asrar; Connolly, Michelle; Kanyal, Ritesh; Demir, Ozan M; Lawson, Lucy O; Wang, Brian; Firoozi, Sam; Spratt, James C; Perera, Divaka; MacCarthy, Philip; Dalby, Miles; Jain, Ajay; Wilson, Simon J; Malik, Iqbal; Rakhit, Roby.
  • Little CD; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom callumlittle@nhs.net.
  • Kotecha T; Institute of Cardiovascular Science, University College London, London, United Kingdom.
  • Candilio L; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Jabbour RJ; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Collins GB; Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Ahmed A; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.
  • Connolly M; Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
  • Kanyal R; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
  • Demir OM; Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
  • Lawson LO; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
  • Wang B; Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom.
  • Firoozi S; Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
  • Spratt JC; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
  • Perera D; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
  • MacCarthy P; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
  • Dalby M; Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
  • Jain A; Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
  • Wilson SJ; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.
  • Malik I; Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
  • Rakhit R; Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom.
Open Heart ; 7(2)2020 10.
Article in English | MEDLINE | ID: covidwho-892315
ABSTRACT

OBJECTIVES:

To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.

METHODS:

We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes

RESULTS:

There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.

CONCLUSION:

These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Outcome and Process Assessment, Health Care / Pneumonia, Viral / Coronavirus Infections / Delivery of Health Care, Integrated / Critical Pathways / Pandemics / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Country/Region as subject: Europa Language: English Year: 2020 Document Type: Article Affiliation country: Openhrt-2020-001432

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Outcome and Process Assessment, Health Care / Pneumonia, Viral / Coronavirus Infections / Delivery of Health Care, Integrated / Critical Pathways / Pandemics / Percutaneous Coronary Intervention / ST Elevation Myocardial Infarction Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Country/Region as subject: Europa Language: English Year: 2020 Document Type: Article Affiliation country: Openhrt-2020-001432