Analysis of data from a US-wide health system suggests that the volume of percutaneous coronary intervention (PCI) procedures for ST-elevation myocardial infarction (STEMI) has yet to return to pre-pandemic levels, having fallen “dramatically” following the onset of COVID-19.
The findings were presented at the Society for Cardiovascular Angiography & Interventions 2022 Scientific Sessions (SCAI 2022; 19 – 22 May, Atlanta, USA) following an analysis of data from the Ascension Health System’s internal National Cardiovascular Data Registry (NCDR). Researchers looked at rates of PCI for STEMI in parallel with COVID-19 surges.
Using data from the NCDR, researchers have found that STEMI PCI cases dropped by nearly 30% following the beginning of the COVID-19 pandemic and have yet to recover to pre-pandemic levels.
Data were abstracted from the NCDR CathPCI registry between March 2018 and June 2021, taken from 42 centres throughout the USA. Timing of the COVID-19 pandemic was assessed with county-level COVID prevalence. A segmented regression analysis with a monthly interrupted time series utilising a linear regression model to quantify expected STEMI PCIs before and after the COVID-19 onset was performed.
The predicted number of PCIs for STEMI was compared to predictions if COVID-19 had not occurred to evaluate differences in STEMI volumes.
STEMI PCI trends increased until pandemic declaration in March 2020 with a rapid decrease which was most acutely seen in April 2020, during the first COVID surge. Thereafter, STEMI PCIs rose consistently until December 2020, during the second COVID surge, when a less severe drop occurred. The segmented regression showed 194 STEMI PCIs done monthly (95% CI 182‒207, p<0.001) with a month-to-month increase of two cases (95% CI 1-2.8, p<0.001). After pandemic declaration, STEMI PCI decreased by 39 (95% CI -60‒-18, p<0.001) per month.
“Our network of PCI centres across the country gives us unique access to data that independent centres may not have,” said Manoj Thangam (Ascension Texas Cardiovascular, Austin, Texas) and lead author of the study. “Despite STEMI rates rising, we have never gotten back to our pre-COVID baseline which probably tells us there is still hesitation to come to the hospital despite having a major heart attack.”
Researchers note a need for continued analysis of other potential consequences and ramifications of untreated STEMI patients that may result in increased mortality, heart failure and morbidities in the aftermath of the COVID-19 pandemic.