Key result
The COVID-19 pandemic was associated with a 45% reduction in STEMI activations (P=0.04) and a significant decrease in out-of-hospital cardiac arrest cases, with no change in door-to-balloon times or mortality for true STEMI cases.
Why the study?
The COVID-19 pandemic greatly affected healthcare delivery worldwide, prompting the need to further characterize changes in cardiac catheterization volume and outcomes for acute coronary syndrome at a single institution.
Does the COVID-19 pandemic reduce cardiac catheterization volume and worsen outcomes in patients with ACS?
Observational (n=204)
No
Does the COVID-19 pandemic reduce cardiac catheterization volume and worsen outcomes in patients with ACS?
Effect estimate: 45% reduction
p-value: p=0.04
The COVID-19 pandemic was associated with a reduction in cardiac catheterization volume for ACS and OHCA, but did not adversely affect door-to-balloon times or short-term mortality for STEMI patients who presented to the hospital.
STEMI and OHCA volumes declined during COVID-19 without harming in-hospital outcomes; leaves open whether reductions reflect avoidance or lower incidence.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected healthcare delivery across the world. In this report, we aim to further characterize the changes in cardiac catheterization at our institution, specifically in the setting of acute coronary syndrome (ACS). METHODS: We performed a retrospective analysis of patients undergoing cardiac catheterization between December 23, 2019 and April 12, 2020 at our institution. All patients with cardiac catheterizations for ACS, ST-elevation myocardial infarction (STEMI) activation, and out-of-hospital cardiac arrest (OHCA) were analyzed. Cardiac catheterization volume, as well as clinical and procedural characteristics of patients undergoing cardiac catheterization, was compared before and during the COVID-19 pandemic. RESULTS: Patients presenting with ACS and OHCA were similar in terms of demographics and comorbidities during both time periods. The mean monthly volume for ACS cases dropped by 26% during the pandemic, which was consistent among both unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and STEMI cases. OHCA volume decreased significantly as well (five cases per month before to zero cases during the pandemic, P = 0.01). Among patients with STEMI, initial markers of cardiac injury, door-to-balloon time, and all-cause mortality were similar in both time periods. CONCLUSIONS: With the start of the COVID-19 pandemic, there was a reduction in cardiac catheterization volume across the spectrum of ACS at our institution, which was consistent with reports from other centers across the globe. Patients with STEMI during the initial phase of the COVID-19 pandemic did not seem to have delays in presentation or significant differences in all-cause mortality at our institution.
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Tan et al. (2020) conducted an observational in Acute Coronary Syndrome (n=204). COVID-19 pandemic vs. Pre-COVID-19 period was evaluated on Number of STEMI activations (45% reduction, p=0.04). The COVID-19 pandemic was associated with a 45% reduction in STEMI activations (P=0.04) and a significant decrease in out-of-hospital cardiac arrest cases, with no change in door-to-balloon times or mortality for true STEMI cases.
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