Impact of COVID-19 on percutaneous coronary intervention utilization and mortality in New York
Edward L Hannan1, Ye Zhong1, Kimberly Cozzens1
1Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, New York, USA.
Insights
COVID-19 significantly reduced percutaneous coronary intervention (PCI) use, especially for non-emergency cases. However, PCI volumes largely recovered by mid-2021, though COVID-19 with ARDS increased PCI patient mortality.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Public Health
Background:
- COVID-19 disrupted healthcare, impacting percutaneous coronary intervention (PCI) utilization and outcomes.
- Little is known about the specific effects on non-emergency PCI patients.
Purpose of the Study:
- To analyze PCI utilization trends and short-term mortality in different patient subgroups during the COVID-19 pandemic.
- To assess the impact of COVID-19 severity on PCI patient mortality.
Main Methods:
- Utilized New York State's PCI registry data from pre-pandemic and pandemic periods (Dec 2018-May 2021).
- Compared PCI volumes and COVID-19 prevalence across four patient severity groups (STEMI to elective).
- Examined risk-adjusted mortality for PCI patients with and without COVID-19, considering ARDS.
Main Results:
- PCI volumes decreased significantly during the pandemic (20-61%), with substantial recovery by Q2 2021 (>90%).
- COVID-19 prevalence in PCI patients was low (1.74-3.66%).
- PCI patients with COVID-19 and ARDS faced significantly higher mortality risk (ORs 10.81-24.53).
Conclusions:
- PCI utilization dropped sharply during COVID-19, varying by patient acuity, but largely rebounded by mid-2021.
- While few PCI patients had active COVID-19, a history of COVID-19 with ARDS increased short-term mortality risk.
- COVID-19 without ARDS or a prior COVID-19 diagnosis did not elevate mortality risk for PCI patients.
Background:
COVID-19 has disrupted the care of all patients, and little is known about its impact on the utilization and short-term mortality of percutaneous coronary intervention (PCI) patients, particularly nonemergency patients.
Methods:
New York State's PCI registry was used to study the utilization of PCI and the presence of COVID-19 in four patient subgroups ranging in severity from ST-elevation myocardial infarction (STEMI) to elective patients before (December 01, 2018-February 29, 2020) and during the COVID-19 era (March 01, 2020-May 31, 2021), as well as to examine the impact of different COVID severity levels on the mortality of different types of PCI patients.
Results:
Decreases in the mean quarterly PCI volume from the prepandemic period to the first quarter of the pandemic ranged from 20% for STEMI patients to 61% for elective patients, with the other two subgroups having decreases in between these values. PCI quarterly volume rebounds from the prepandemic period to the second quarter of 2021 were in excess of 90% for all patient subgroups, and 99.7% for elective patients. Existing COVID-19 was rare among PCI patients, ranging from 1.74% for STEMI patients to 3.66% for elective patients. PCI patients with COVID-19 and acute respiratory distress syndrome (ARDS) who were not intubated, and PCI patients with COVID-19 and ARDS who were either intubated or were not intubated because of Do Not Resuscitate//Do Not Intubate status had higher risk-adjusted mortality ([adjusted ORs = 10.81 [4.39, 26.63] and 24.53 [12.06, 49.88], respectively]) than patients who never had COVID-19.
Conclusions:
There were large decreases in the utilization of PCI during COVID-19, with the percentage of decrease being highly sensitive to patient acuity. By the second quarter of 2021, prepandemic volumes were nearly restored for all patient subgroups. Very few PCI patients had current COVID-19 throughout the pandemic period, but the number of PCI patients with a COVID-19 history increased steadily during the pandemic. PCI patients with COVID-19 accompanied by ARDS were at much higher risk of short-term mortality than patients who never had COVID-19. COVID-19 without ARDS and history of COVID-19 were not associated with higher mortality for PCI patients as of the second quarter of 2021.
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