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Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Before and During COVID in New York
Edward L Hannan1, Yifeng Wu1, Kimberly Cozzens1
1University at Albany, State University of New York, Albany, New York.
Insights
During the COVID-19 pandemic, ST-elevation myocardial infarction (STEMI) percutaneous coronary interventions (PCI) decreased significantly in high-density COVID-19 counties. This reduction was due to patients delaying hospital visits, not a lack of treatment availability.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Regional variations in ST-elevation myocardial infarction (STEMI) patient care during the COVID-19 pandemic remain understudied.
- Understanding treatment and outcome differences is crucial for public health interventions.
Purpose of the Study:
- To compare STEMI percutaneous coronary intervention (PCI) volumes, treatments, and outcomes between pre-pandemic and pandemic periods.
- To analyze regional differences based on COVID-19 density in New York State hospitals.
Main Methods:
- Retrospective analysis of 51 New York State hospitals performing PCI for STEMI.
- Comparison of data from March 15, 2020 - April 4, 2020 (COVID period) versus January 1, 2019 - March 14, 2020 (pre-COVID period).
- Hospitals categorized by COVID-19 death density (high vs. low).
Main Results:
- A 43% weekly decrease in STEMI PCI procedures in high-density COVID-19 counties versus a 4% decrease in low-density counties.
- No significant change in risk-adjusted in-hospital mortality rates across county types.
- STEMI PCI patients in high-density counties experienced longer symptom onset to hospital arrival times and lower cardiac arrest rates during the pandemic.
Conclusions:
- The decline in STEMI PCI procedures during the pandemic was concentrated in high COVID-19 death density regions.
- This decrease was primarily attributed to patients delaying hospital presentation, not a reduction in PCI availability or STEMI incidence.
- High-density COVID-19 counties saw delayed STEMI admissions and less severe patient presentations during the pandemic, highlighting the need to encourage timely hospital care.
Abstract:
Little is known about regional differences in volume, treatment, and outcomes of STEMI patients undergoing PCI during the pandemic. The objectives of this study were to compare COVID-19 pandemic and prepandemic periods with respect to regional volumes, outcomes, and treatment of patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 1, 2019 and March 14, 2020 (pre-COVID period) and between March 15, 2020 and April 4, 2020 (COVID period) in 51 New York State hospitals certified to perform PCI. The hospitals were classified as being in either high-density or low-density COVID-19 counties on the basis of deaths/10,000 population. There was a decrease of 43% in procedures/week in high-density COVID-19 counties (p <0.0001) and only 4% in low-density counties (p = 0.64). There was no difference in the change in risk-adjusted in-hospital mortality rates in either type of county, but STEMI PCI patients in high-density counties had longer times from symptom onset to hospital arrival and lower cardiac arrest rates in the pandemic period. In conclusion, the decrease in STEMI PCIs during the pandemic was mainly limited to counties with a high density of COVID-19 deaths. The decrease appears to be primarily related to patients not presenting to hospitals in high-density COVID regions, rather than PCI being avoided in STEMI patients or a reduction in the incidence of STEMI. Also, high-density COVID-19 counties experienced delayed admissions and less severely ill STEMI PCI patients during the pandemic. This information can serve to focus efforts on convincing STEMI patients to seek life-saving hospital care during the pandemic.
