Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction
Chun Shing Kwok1, Chris P Gale2, Tim Kinnaird1,3
1Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK.
Insights
During COVID-19, primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England decreased. However, in-hospital outcomes for STEMI patients remained unaffected despite longer symptom-to-hospital and door-to-balloon times.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly impacted healthcare systems globally.
- Understanding its effect on acute cardiovascular interventions like primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is crucial.
Purpose of the Study:
- To analyze changes in primary PCI procedural volumes for STEMI in England during the COVID-19 pandemic.
- To assess the impact of these changes on patient clinical characteristics and in-hospital outcomes.
Main Methods:
- A retrospective cohort study utilizing the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database.
- Analysis included 44 hospitals reporting PCI activity between January 2017 and April 2020, focusing on primary PCI for STEMI patients.
Main Results:
- A 43% decline in monthly primary PCI procedures for STEMI was observed in April 2020 compared to the 2017-2019 average.
- Median symptom-to-hospital and door-to-balloon times increased post-lockdown.
- No significant difference in in-hospital mortality or major adverse cardiovascular events was found after adjusting for baseline characteristics.
Conclusions:
- The COVID-19 lockdown in England led to a reduction in primary PCI procedures for STEMI and increased patient delays.
- Despite these challenges, the restructuring of health services did not adversely affect in-hospital outcomes for STEMI patients.
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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