Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

Mohamed O. Mohamed; Nick Curzen; Mark de Belder; Andrew Goodwin; James Spratt; Lognathen Balacumaraswami; John Deanfield; Glen P. Martin; Muhammad Rashid; Ahmad Shoaib; Chris P Gale; Tim Kinnaird; Mamas A. Mamas

doi:10.1002/ccd.29663

March 25, 2021Catheterization and Cardiovascular InterventionsOpen Access

Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

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Why the study?

Data were limited regarding how the COVID-19 pandemic affected left main coronary revascularisation activity, the choice between PCI and CABG, and post-procedural outcomes.

Does the COVID-19 pandemic affect the choice of revascularisation strategy and post-procedural mortality in patients with significant left main coronary disease?

Structured PICO

Does the COVID-19 pandemic affect the choice of revascularisation strategy and post-procedural mortality in patients with significant left main coronary disease?

P

Population

22,235 patients with left main (LM) coronary disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020

I

Intervention

Coronary revascularisation (PCI or CABG) during the COVID-19 pandemic period (March 1, 2020 to August 19, 2020)

C

Comparator

Coronary revascularisation (PCI or CABG) during the pre-COVID period (January 1, 2017 to February 29, 2020)

O

Outcome

Receipt of CABG (vs. PCI), in-hospital mortality, and 30-day postprocedural mortalityhard clinical

The COVID-19 pandemic led to a significant decline in left main revascularisation and a shift towards PCI over CABG, without compromising short-term mortality outcomes.

Implication

Declining LM revascularisation volumes with PCI shift during COVID merit surveillance for unmet need; leaves open long-term outcome questions in observational data.

Abstract

BACKGROUND: There are limited data on the impact of the COVID-19 pandemic on left main (LM) coronary revascularisation activity, choice of revascularisation strategy, and post-procedural outcomes. METHODS: All patients with LM disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020 were included (n = 22,235), stratified by time-period (pre-COVID: 01/01/2017-29/2/2020; COVID: 1/3/2020-19/8/2020) and revascularisation strategy (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of 1) receipt of CABG (vs. PCI) and 2) in-hospital and 30-day postprocedural mortality, in the COVID-19 period (vs. pre-COVID). RESULTS: There was a decline of 1,354 LM revascularisation procedures between March 1, 2020 and July 31, 2020 compared with previous years' (2017-2019) averages (-48.8%). An increased utilization of PCI over CABG was observed in the COVID period (receipt of CABG vs. PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in-hospital or 30-day mortality was observed between pre-COVID and COVID periods for both PCI (odds ratio (OR): 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups. CONCLUSION: LM revascularisation activity has significantly declined during the COVID period, with a shift towards PCI as the preferred strategy. Postprocedural mortality within each revascularisation group was similar in the pre-COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularisation activity to pre-COVID levels.