45 Evaluating the impact of COVID-19 on regional primary percutaneous coronary intervention service during the first wave of COVID-19

Résumé fourni par la source

Aims Primary Percutaneous Coronary Intervention (pPCI) remains the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the impact of first wave of COVID-19 on our pPCI service; was there a reduction in the number of pPCIs performed? Were referrals to the pPCI service inappropriately turned down? Methods Retrospective observational study of all referrals to the Belfast pPCI service between 23rd March 2020 and 9th June 2020. All electrocardiograms (ECGs) were reviewed with corresponding referral history logged on a Microsoft Access database and call log sheets. Supplementary clinical data was collected using the Northern Ireland Electronic Care Record (NIECR). A turn down was deemed inappropriate if retrospective review of history and ECG demonstrated that the pPCI pathway entry criteria had been met. The number of pPCIs performed was compared with the same time period in 2019. Results A total of 388 referrals were made to the Belfast pPCI service over a period of 78 days [figure 1]. 19 invalid referrals were excluded, 15 with missing ECGs and 4 duplicate referrals. 134 patients were accepted for pPCI and 235 referrals were turned down, of which 9 (4%) were deemed inappropriate. No referrals were turned down due to COVID-19. Of the inappropriate turned downs 6 were re-referred and had pPCI to a culprit coronary artery, 2 had routine PCI to a culprit coronary artery and 1 had Takotsubo syndrome. From the accepted cohort, 114 (85%) had pPCI to a culprit coronary artery and 20 (15%) had no intervention (3 Takotsubo syndrome, 1 coronary spasm, 4 pericarditis, 3 chronic total occlusion of coronary artery, 8 non-obstructive coronary artery disease and 1 stroke). In the appropriately turned down cohort, the final diagnosis was cardiac in 127 (53%) patients, non-cardiac chest pain in 25 (11%), miscellaneous in 67 (29%) and COVID-19 in 16 (7%) [table 2]. One-year mortality rate of the turned down cohort was 16% (38/235) of which 55% (21/38) was in the cohort with a final cardiac diagnosis, 13% (5/38) was due to COVID-19 and the remaining 32% (12/38) from the miscellaneous cohort [table 1 and 2]. In 2020 there was a 29% (130 vs 182) reduction in the number of pPCIs performed in the 3 months from March to May in comparison with the previous year [figure 2]. Conclusions During the first wave of COVID-19 there was a significant reduction in the number of pPCIs performed. This was not due to an increase in inappropriate turn down of referrals. No patient was turned down because of COVID-19. Of the turned down patients the majority (53%) had a final cardiac diagnosis. One year mortality in this group was significant.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.