Key result
Strict COVID-19 isolation was associated with a significant reduction in mean weekly cardiac catheterizations for NSTEMI/UA compared to pre-isolation (8.29 vs. 12.5 cases, P=0.019), which rebounded by 27% when isolation relaxed.
Why the study?
The study sought to investigate the trajectory of cardiac catheterizations for ACS and OHCA across pre-isolation, strict-isolation, and relaxed-isolation periods of the COVID-19 pandemic.
Does the intensity of COVID-19 isolation policies affect the volume of urgent or emergent cardiac catheterizations for ACS and OHCA?
Observational (n=377)
Yes
Does the intensity of COVID-19 isolation policies affect the volume of urgent or emergent cardiac catheterizations for ACS and OHCA?
Absolute Event Rate: 8.29% vs 12.5%
p-value: p=0.019
Suggests possible delayed ACS presentations during strict isolation; leaves open whether pandemic policies causally altered catheterization volumes.
BACKGROUND: We sought to investigate the trajectory of cardiac catheterizations for acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA) during the pre-isolation (PI), strict-isolation (SI), and relaxed-isolation (RI) periods of the coronavirus disease 2019 (COVID-19) pandemic at three hospitals in Los Angeles, CA, USA. METHODS: A retrospective analysis was conducted on adult patients undergoing urgent or emergent cardiac catheterization for suspected ACS or OHCA between January 1, 2020 and June 2, 2020 at three hospitals in Los Angeles, CA, USA. We designated January 1, 2020 to March 17, 2020 as the PI COVID-19 period, March 18, 2020 to May 5, 2020 as the SI COVID-19 period, and May 6, 2020 to June 2, 2020 as the RI COVID-19 period. RESULTS: From PI to SI, there was a significant reduction in mean weekly cases of catheterizations for non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA) (8.29 vs. 12.5, P = 0.019), with all other clinical categories trending downwards. From SI to RI, mean weekly cases of catheterizations for total ACS increased by 17%, NSTEMI/UA increased by 27%, and OHCA increased by 32%, demonstrating a "rebound effect". CONCLUSIONS: Cardiac catheterizations for ACS and NSTEMI/UA exhibited a "rebound effect" once social isolation was relaxed.
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Desai et al. (2020) conducted an observational in Acute Coronary Syndrome and Out-of-Hospital Cardiac Arrest (n=377). Strict COVID-19 isolation vs. Pre-isolation was evaluated on Mean weekly cases of cardiac catheterizations for NSTEMI/UA (p=0.019). Strict COVID-19 isolation was associated with a significant reduction in mean weekly cardiac catheterizations for NSTEMI/UA compared to pre-isolation (8.29 vs. 12.5 cases, P=0.019), which rebounded by 27% when isolation relaxed.
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