Fewer severe heart attack patients underwent PCI during the early months of the pandemic
The COVID-19 pandemic led to a significant drop in the number of ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), according to new research published in the American Journal of Cardiology.
“Prior studies have demonstrated that catheterization laboratory activations for STEMI as well as hospitalizations for STEMI and related conditions have decreased during the COVID-19 pandemic,” wrote lead author Edward L. Hannan, PhD, of the University of Albany in New York, and colleagues. “However, they did not thoroughly investigate differences in patient characteristics, processes of care, and outcomes between the pandemic and pre-pandemic periods that could enhance further understanding of the impact of the pandemic on STEMI patients.”
Hannan et al. gathered data from more than 7,000 patients who received care at one of 51 different hospitals in New York. All data came from the state’s mandatory PCI registry. More than 6,500 patients received care before the pandemic—from Jan. 1, 2019 to March 14, 2020—and the remaining patients received care from March 15 to April 25, 2020.
March 15 was chosen as the “demarcation time,” the authors explained, because that was when the U.S. government pushed states to enforce social distancing policies due to COVID-19.
Overall, the number of patients undergoing PCI for STEMI dropped by 24% across New York. The drop was 43% in high-density parts of the state and 4% in low-density areas.
One potential explanation suggested by the authors is that patients are still presenting to the hospital after a STEMI—but not actually undergoing PCI. According to a separate survey of 41 hospitals, however, the percentage of STEMI patients undergoing PCI only dropped from 91.4% to 89.7%.
Another possible explanation is that people lived a “less frenetic lifestyle” during those early stages of the pandemic. But if that was the case, the authors explained, low-density areas would have likely seen a more dramatic shift.
The research team also aimed to learn anything they could about STEMI patients with COVID-19 who were undergoing PCI. This was not common, the team observed, but when it did occur, the in-hospital mortality rate was “significantly higher” than in a normal scenario.
“It should be noted that most asymptomatic patients in the pandemic study period were not tested for COVID-19 due to the limited testing availability at the time,” the authors wrote. “Therefore, the impact of asymptomatic COVID-19 on PCI outcomes is unknown.”
The team shared a few other key findings when comparing patient care before and during the pandemic:
- Lengths of stay were shorter in both high-density and low-density areas.
- In-hospital mortality rates did not change.
- STEMI patients undergoing PCI were less likely to have a cardiac arrest, which the authors speculated was “because they died at home or in ambulances during the pandemic”
The full analysis can be read here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.