Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction
Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction
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.
1805-1811
Kwok, Chun Shing
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Gale, Chris P
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Kinnaird, Tim
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Curzen, Nick
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Ludman, Peter
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Kontopantelis, Evan
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Wu, Jianhua
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Denwood, Tom
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Fazal, Nadeem
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Deanfield, John
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De Belder, Mark A
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Mamas, Mamas
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1 December 2020
Kwok, Chun Shing
000170fb-8506-4c19-9481-e56d93049fef
Gale, Chris P
96b5706c-fd86-4b41-9568-3d917ef2c805
Kinnaird, Tim
3cfe5aa5-eb28-4a4d-b2e4-6ea0799d85d0
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ludman, Peter
28ef305d-e09e-40a7-84b4-6ccedfb37cc8
Kontopantelis, Evan
80980bf2-f5d8-4cb4-a348-02250af00915
Wu, Jianhua
d1e83015-b7d2-4404-847e-c6f73e281759
Denwood, Tom
ebadd107-476e-4390-8829-3c96c917bfe1
Fazal, Nadeem
3d9596d8-70e7-4b89-b282-63982762af72
Deanfield, John
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De Belder, Mark A
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Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Kwok, Chun Shing, Gale, Chris P, Kinnaird, Tim, Curzen, Nick, Ludman, Peter, Kontopantelis, Evan, Wu, Jianhua, Denwood, Tom, Fazal, Nadeem, Deanfield, John, De Belder, Mark A and Mamas, Mamas
(2020)
Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction.
Heart, 106 (23), .
(doi:10.1136/heartjnl-2020-317650).
Abstract
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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Published date: 1 December 2020
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This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
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Local EPrints ID: 453732
URI: http://eprints.soton.ac.uk/id/eprint/453732
ISSN: 1355-6037
PURE UUID: 462d8673-7fc9-4e3c-843e-80e8c72abb1d
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Date deposited: 21 Jan 2022 17:41
Last modified: 17 Mar 2024 03:02
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Contributors
Author:
Chun Shing Kwok
Author:
Chris P Gale
Author:
Tim Kinnaird
Author:
Peter Ludman
Author:
Evan Kontopantelis
Author:
Jianhua Wu
Author:
Tom Denwood
Author:
Nadeem Fazal
Author:
John Deanfield
Author:
Mark A De Belder
Author:
Mamas Mamas
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