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Coronary artery disease
Original research
Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction
  1. Chun Shing Kwok1,
  2. Chris P Gale2,
  3. Tim Kinnaird1,3,
  4. Nick Curzen4,
  5. Peter Ludman5,
  6. Evan Kontopantelis6,
  7. Jianhua Wu7,8,
  8. Tom Denwood9,
  9. Nadeem Fazal10,
  10. John Deanfield10,
  11. Mark A de Belder10,
  12. Mamas Mamas1
  1. 1 Keele Cardiovascular Research Group, Keele University, Keele, Staffordshire, UK
  2. 2 Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
  3. 3 Department of Cardiology, University Hospital of Wales, Cardiff, UK
  4. 4 Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  5. 5 Institute of Cardiovascular Sciences, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  6. 6 Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, Greater Manchester, UK
  7. 7 Leeds Institute for Data Analytics, University of Leeds, Leeds, West Yorkshire, UK
  8. 8 Division of Clinical and Translational Research, School of Dentistry, University of Leeds, Leeds, UK
  9. 9 NHS Digital, Leeds, UK
  10. 10 National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Mamas Mamas; mamasmamas1{at}yahoo.co.uk

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.

  • percutaneous coronary intervention
  • acute myocardial infarction

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.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/heartjnl-2020-317650

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    Footnotes

    • Twitter @DrShingKwok, @cpgale3, @NickCurzen, @dataevan, @MMamas1973

    • Contributors MM was responsible for the study design and concept. CSK performed the data cleaning and analysis. CSK and MM wrote the first draft of the manuscript, and all authors contributed to the writing of the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval In the efforts to understand the impact of the COVID-19 pandemic on cardiology services, extraordinary government permission was obtained to evaluate anonymised records from this database through an agreement with NHS Digital. This work was endorsed by: (A) Scientific Advisory Group for Emergencies (a body responsible for ensuring timely and coordinated scientific advice is made available to decision makers to support UK cross-government decisions in the Cabinet Office Briefing Room), (B) NHS England, a public body of the Department of Health and Social Care and (C) NHS Improvement, responsible for overseeing NHS trusts. NICOR, which houses the British Cardiovascular Intervention Society registry, has support under section 251 of the NHS Act 2006 to use patient information for approved medical research without informed consent. For this rapid NHS evaluation, health data analysis was enabled under Section 254 of the Health and Social Care Act 2012.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.

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