June 2020 | Issue 57
COVID-19 linked to a near 40% drop in STEMI cases in US cath labs
Santiago Garcia (Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, USA) and colleagues report in the Journal of American College of Cardiology that there was a 38% drop in cath lab ST-segment elevation myocardial infarction (STEMI) activations in the USA after the COVID-19 pandemic started to substantially affect US social life and medical operations (1 March 2020). The authors suggest that this could be because patients are avoiding seeking medical attention for fear of contracting the virus in hospital.
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arcia et al write that the US Centers for Disease Control and Prevention (CDC), to preserve resources such as hospital beds, recommended, at the start of the pandemic, deferring elective procedures— for example, percutaneous coronary intervention (PCI) for patients with stable coronary artery disease. However, they add that both the Society for Cardiac Angiography and Interventions (SCAI) and the American College of Cardiology (ACC) advise that primary PCI should still be performed in STEMI patients regardless of whether or not elective procedures are being performed. According to the authors, anecdotal evidence suggests that the number of primary PCI procedures in the USA and across the globe have declined since the outbreak began. “To determine if a decrease in primary PCI is occurring in the USA in the COVID-19 era, we analysed and quantified STEMI activation for nine high-volume cardiac catheterisation laboratories from 1 January 2019 to 31 March 2020,” they write. Using a mixed model, Garcia et al compared STEMI activations that occurred between 1 January 2019 and 29 February 2020 with those that occurred between 1 March 2020 and 31 March 2020. 1 March was chosen as the start of the “after COVID” period because that was when, the authors note, US social life and medical operations started to be significantly affected. In particular, New York City (the epicentre of the virus in the USA) reported its first case on 1 March and the US government recommended social distancing on 15 March. The mixed model showed an estimated 38% reduction in cardiac catheterisation laboratory STEMI activations in March 2020, compared with the previous 14 months. The authors comment: “All sites combined reported >180 STEMI activations in the before COVID-19 period. In contrast, all sites combined reported only 138 activations.” They say that the 38% reduction is similar to a 40% reduction that has been seen in Spain.
Santiago Garcia
Deepak Bhatt
Garcia et al observe that, during the pandemic, activations might have been expected to go up “given the potential heightened environmental and psychological stressors”. Cases of STEMI induced by viral illness and STEMI mimickers such as COVID-19 myopericarditis may also have theoretically caused activations to increase. “Potential aetiologies for the decrease in STEMI primary PCI activations include avoidance of medical care due to social distancing or concerns of contracting COVID-19 in hospital, STEMI misdiagnosis, and increased use of pharmacological reperfusion due to COVID-19,” the authors speculate.
It is particularly crucial to understand if patient-based anxiety is decreasing presentation of STEMI patients to the US hospital system.”
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Survey provides insights into how to tackle COVID-19 elective backlog A BIBA MedTech Insights survey indicates that 50% of centres performing structural heart procedures believe that they will need to increase the number of operating days per week to manage the elective cases that have been put on hold because of COVID-19. However, 22% believe that no extra measures will be required and the backlog will be cleared in time. THE GLOBAL OUTBREAK of COVID-19, and its impact on healthcare resources, prompted many centres to postpone, or at least reduce, the elective procedures that they were performing. However, there are concerns that delayed procedures will lead to poorer prognosis in the long term for patients whose conditions may worsen because of lack of intervention. Additionally, postponement may cause a large backlog that will need to be addressed once elective procedures start to be reintroduced. To better understand the impact of COVID-19 on elective procedures, BIBA MedTech Insights polled centres across the USA and Europe, asking interventional cardiologists and cardiac surgeons about the structural heart procedures that they were currently performing. Out of 220 centres, 49% said that they were only performing procedures for the most critical patients and 26% said that they were not performing any procedures at all. However, Continued on page 4
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