Single Center Trends in Acute Coronary Syndrome Volume and Outcomes During the COVID-19 Pandemic
Weiyi Tan1, Rushi V Parikh1, Rebecca Chester1
1Division of Cardiology, University of California, Los Angeles, CA, USA.
Insights
The COVID-19 pandemic reduced cardiac catheterization volumes for acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA) patients. However, ST-elevation myocardial infarction (STEMI) patients experienced no significant delays or increased mortality during this period.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted global healthcare delivery systems.
- Understanding its impact on cardiovascular interventions, particularly for acute coronary syndrome (ACS), is crucial.
- This study focuses on changes in cardiac catheterization procedures during the pandemic at a single institution.
Purpose of the Study:
- To characterize the changes in cardiac catheterization volume and patient profiles for ACS during the COVID-19 pandemic.
- To compare procedural characteristics and outcomes for ST-elevation myocardial infarction (STEMI) before and during the pandemic.
- To assess the impact of the pandemic on out-of-hospital cardiac arrest (OHCA) interventions.
Main Methods:
- Retrospective analysis of cardiac catheterization data from December 2019 to April 2020.
- Inclusion criteria: ACS, STEMI activation, and OHCA patients.
- Comparison of patient demographics, comorbidities, cardiac catheterization volumes, and procedural times between pre-pandemic and pandemic periods.
Main Results:
- A 26% decrease in mean monthly ACS cases (STEMI and non-STEMI) was observed during the pandemic.
- Significant reduction in OHCA cases (from 5/month to 0/month, P=0.01).
- STEMI patients showed similar demographics, comorbidities, initial cardiac injury markers, door-to-balloon times, and all-cause mortality in both periods.
Conclusions:
- Cardiac catheterization volumes for ACS spectrum conditions decreased during the initial COVID-19 pandemic phase, aligning with global trends.
- Patients with STEMI did not experience presentation delays or increased mortality at this institution during the early pandemic.
- The findings highlight the need for continued cardiac care amidst public health crises.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has greatly affected healthcare delivery across the world. In this report, we aim to further characterize the changes in cardiac catheterization at our institution, specifically in the setting of acute coronary syndrome (ACS).
Methods:
We performed a retrospective analysis of patients undergoing cardiac catheterization between December 23, 2019 and April 12, 2020 at our institution. All patients with cardiac catheterizations for ACS, ST-elevation myocardial infarction (STEMI) activation, and out-of-hospital cardiac arrest (OHCA) were analyzed. Cardiac catheterization volume, as well as clinical and procedural characteristics of patients undergoing cardiac catheterization, was compared before and during the COVID-19 pandemic.
Results:
Patients presenting with ACS and OHCA were similar in terms of demographics and comorbidities during both time periods. The mean monthly volume for ACS cases dropped by 26% during the pandemic, which was consistent among both unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and STEMI cases. OHCA volume decreased significantly as well (five cases per month before to zero cases during the pandemic, P = 0.01). Among patients with STEMI, initial markers of cardiac injury, door-to-balloon time, and all-cause mortality were similar in both time periods.
Conclusions:
With the start of the COVID-19 pandemic, there was a reduction in cardiac catheterization volume across the spectrum of ACS at our institution, which was consistent with reports from other centers across the globe. Patients with STEMI during the initial phase of the COVID-19 pandemic did not seem to have delays in presentation or significant differences in all-cause mortality at our institution.
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