A significant decline in percutaneous coronary intervention (PCI) procedures was seen in England early on in 2020 due to the lockdown enforced in the country during the first wave of the COVID-19 pandemic. This is according to a paper published in the journal Circulation: Cardiovascular Interventions looking at the changes in PCI practice throughout England during the pandemic, looking at changes in clinical presentation, characteristics of patients and their clinical outcomes.
However, despite fresh restrictions having come into force in the country this week amid a rising number of COVID-19 hospital admissions, a senior author of the study has told Cardiovascular News that he does not expect to see a drop-off in procedures of the same magnitude as that early in the year.
Led by Chun Shing Kwok and Mamas Mamas (Keele University, Newcastle-Under-Lyme, UK) the study team conducted a retrospective cohort study of all patients who underwent PCI in England between January 2017 and April 2020 using data taken from the British Cardiovascular Intervention Society database.
In total, data was taken from 44 hospitals, who recorded PCI procedures for 126,491 patients. In the week prior to the lockdown, which was brought into effect in England in late March, there were around 700 PCI procedures performed each week, according to the data. However, after 23 March 2020, this fell by around 49%.
Writing in Circulation, the study team reports that the decrease was greatest in PCI procedures performed for stable angina (66%), followed by non-ST-segment-elevation myocardial infarction (45%), and ST-segment-elevation myocardial infarction (33%).
Patients seen after the lockdown were younger (64.5 vs. 65.5 years, p<0.001) and less likely to have diabetes (20.4% vs. 24.6%, p<0.001), hypertension (52.0% versus 56.8%, p=0.001), previous myocardial infarction (23.5% vs. 26.7%, p=0.008), previous PCI (24.3% vs. 28.3%, p=0.001), or previous coronary artery bypass graft (4.6% vs. 7.2%, p<0.001) compared with before the lockdown, the study team found.
In conclusion, they write: “The lockdown in England has resulted in a significant decline in PCI procedures. Fewer patients underwent PCI for stable angina. This enabled greater capacity for urgent and emergency cases, and a reduced length of stay was seen for such patients. Significant changes in the characteristics of patients towards a lower risk phenotype were observed, particularly for non–ST-segment–elevation myocardial infarction, reflecting a more conservative approach to this cohort.”
With England’s population now under a second round of tightened restrictions due to a rise in COVID-19 cases and hospitalisations, Mamas considered the likelihood of a similar drop in the volume of procedures late in the year.
Speaking to Cardiovascular News, he said: “Several centres are cancelling elective activity to increase capacity for the increase in COVID-19 admissions that certain trusts are experiencing. This will serve to reduce elective PCI activity during the second wave, although it is likely that the decrease will not be as significant as it was during the first wave. What remains to be seen is whether we will also see a similar decline in acute coronary (ACS) admissions as was observed during the first wave, where we reported parallel increases in out of hospital cardiac arrests, death from ACS and heart failure in the community in our other work. Overall i suspect that we will see a drop in PCI activity, but this will not be as significant as the first wave.”