Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

Q: What are the key findings of this study?

During the early phase of the COVID-19 pandemic, U.S. cardiac catheterization laboratory STEMI activations decreased by an estimated 38% compared to the pre-pandemic period.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (STEMI). Intervention: COVID-19 pandemic (After COVID-19 period) vs. Before COVID-19 period (January 1, 2019, to February 29, 2020). Primary outcome: STEMI activations per site per month (38% decrease, 95% CI 26% to 49%, p=<0.001).

Q: What does this research mean for the field?

Cardiac catheterization laboratory activations for ST-segment elevation myocardial infarction decreased by an estimated 38% in the United States during the early phase of the COVID-19 pandemic. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine whether cardiac catheterization laboratory activations for ST-segment elevation myocardial infarction declined across the United States during the early phase of the COVID-19 pandemic.

Santiago García; Mazen Albaghdadi; Perwaiz Meraj; Christian Schmidt; Ross Garberich; Farouc A. Jaffer; Simon Dixon; Jeffrey J. Rade; Mark Tannenbaum; Jenny Chambers; Paul P. Huang; Timothy D. Henry

doi:10.1016/j.jacc.2020.04.011

April 10, 2020Journal of the American College of CardiologyOpen Access

Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

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Key result

Early COVID-19 pandemic linked to ~38% drop in U.S. cath lab STEMI activations.

38% decrease
95% CI 26% to 49%
P<0.001

Key Points

To determine whether cardiac catheterization laboratory activations for ST-segment elevation myocardial infarction declined across the United States during the early phase of the COVID-19 pandemic.
Quantified monthly STEMI activations across 9 high-volume (>100 PPCIs/year) cardiac catheterization laboratories in the United States from January 1, 2019, to March 31, 2020.
Defined the pre-pandemic baseline as January 1, 2019, to February 29, 2020, and the early pandemic period as March 1, 2020, to March 31, 2020.
Used a mixed model with random intercepts adjusted for time as a continuous variable to evaluate percentage changes in activation rates.
STEMI activations decreased by 38% (95% confidence interval: 26% to 49%; p < 0.001) during the early pandemic period compared with the pre-pandemic baseline.
Combined monthly activations exceeded 180 across all sites (mean 23.6 activations/month) before March 2020, dropping to 138 activations (mean 15.3 activations/month) in March 2020.

Study Design

Type

Observational

Multicenter

Yes

PICO

P

Population

STEMI activations from 9 high-volume cardiac catheterization laboratories in the United States were analyzed to compare volumes before and after the onset of the COVID-19 pandemic.

E

Exposure / Comparator

COVID-19 pandemic (After COVID-19 period) vs Before COVID-19 period (January 1, 2019, to February 29, 2020)

O

Primary Outcome

STEMI activations per site per month — 38% decrease (26% to 49%), p=<0.001

Main Result

Effect estimate: 38% decrease (95% CI 26% to 49%)

Absolute Event Rate: 15.3% vs 23.6%

p-value: p=<0.001

Limitations

Preliminary analysis restricted to the early phase of the COVID-19 pandemic
Underlying causes for the decrease (e.g., avoidance of medical care, STEMI misdiagnosis, increased pharmacological reperfusion) could not be definitively determined

Implication

Analysis reveals reduced cardiac catheterization activations in the U.S. during the COVID-19 pandemic, indicating resource allocation challenges.

Abstract

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Discussion

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Cite This Study

García et al. (2020) conducted an observational in ST-segment elevation myocardial infarction (STEMI). COVID-19 pandemic (After COVID-19 period) vs. Before COVID-19 period (January 1, 2019, to February 29, 2020) was evaluated on STEMI activations per site per month (38% decrease, 95% CI 26% to 49%, p=<0.001). During the early phase of the COVID-19 pandemic, U.S. cardiac catheterization laboratory STEMI activations decreased by an estimated 38% compared to the pre-pandemic period.

synapsesocial.com/papers/6a63a2f3c1251d7575466970 https://doi.org/10.1016/j.jacc.2020.04.011

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Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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