Two research papers presented at the Society for Cardiovascular Angiography and Interventions virtual scientific sessions (SCAI 2021, 28 April–1 May, virtual) offer a glimpse of the stark impact of the COVID-19 pandemic on cardiovascular care.
This includes findings from the North American COVID-19 (NACMI) Registry presented in a late-breaking trial session at SCAI 2021, detailing the impact of the pandemic on ST-Elevation Myocardial Infarction (STEMI) patients in North American hospitals.
Data were collected from more than 1,600 patients, including 331 STEMI patients with COVID-19, 645 suspected COVID-19 positive patients and a control group of 662 age and sex matched STEMI patients treated pre-COVID-19. The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction or repeat unplanned revascularization.
The prospective, ongoing observational registry was a joint undertaking between the American College of Cardiology (ACC) Interventional Council, Canadian Association of Interventional Cardiology, and the Society for SCAI, with an overall goal to understand demographic characteristics, management strategies and outcomes of COVID-19 patients with STEMI.
Results reveal in these series of STEMI activations during the COVID-era, patients who tested positive for COVID-19 were less likely to receive diagnostic angiograms, while those with COVID-19 positive status had higher in-hospital mortality.
Findings also show that COVID-19 positive patients were more likely to be of minority ethnicity, have diabetes and undergo medical therapy as a first-line treatment rather than percutaneous coronary intervention (all p <0.001 relative to PUI). Results also indicated that STEMI patients have higher survival rates when receiving timely access to primary PCI. Among COVID-19 positive patients who received angiography, 69% received PCI and 20% had no culprit vessels identified on angiography (both p <0.01 relative to controls). The primary outcome, composite of all-cause death or MI or stroke occurred in 35% of COVID-19 positive patients, 14% of suspected COVID-19 positive patients and 5% of control patients (p<0.001 relative to controls).
“Leading clinicians and researchers have quickly and efficiently come together to understand the relationship between COVID-19 and heart attacks. This registry is an amazing feat of collaboration, speed and scale involving more than 60 sites, and three leading medical societies across the United States and Canada,” said co-lead investigator Payam Dehghani (University of Saskatchewan, Regina, Saskatchewan, Canada) who presented the results at SCAI 2021. “We’re seeing an alarming trend of the deadly impact of this pandemic on high-risk minority heart attack patients. This ongoing registry’s goal is to help illuminate these disparity trends and inform future preventive and treatment strategies for this COVID-19 era.”
The authors of the investigational registry are planning to conduct additional research to further understand the impact on specific minority and diabetic patient populations. In addition, investigators plan to follow up at one year to verify findings.
70% in AMI cases during first wave
Results of a retrospective observational study, delivered in a poster presentation by Nina Talmor, (NYU Langone Health, New York, USA) also point to a 70% reduction in acute myocardial infarction (AMI) cases referred for invasive angiography in April 2020 compared to April 2019—at the height of the first wave of the pandemic.
The study’s results showed that only 13 patients with AMI underwent invasive angiography at the institution in April 2020, compared to 59 in 2019—a drop of 70%. No differences in demographics, comorbidities, or baseline medications between the two time periods were observed. There was a numerically greater proportion of STEMI presentations (39% vs 20%, p=0.30) and a longer median delay from symptom onset to hospital presentation (70.7 vs 34.2 hours, p=0.06) in 2020 versus 2019, the study team found.
Multivessel coronary disease was less common (31% vs 73%, p=0.01) but peak troponin concentrations were higher (83.92 vs. 19.49 ng/mL, p = 0.01) in 2020 versus 2019.
The single-centre retrospective observational study was intended to compare characteristics and outcomes of patients with AMI during the peak of the pandemic. Investigators noted no differences in demographics, comorbidities or baseline medications before or after the pandemic. Multi-vessel coronary disease was less common, but peak troponin concentrations were higher in 2020 than in the previous year, Talmor detailed.
“I think the reason why peak troponin levels were higher during the pandemic compared to previously is that patients tended to present later after symptom onset, so they probably were staying at home with symptoms for a longer period of time, allowing things to progress for longer before they came in to seek care,” Talmor told Cardiovascular News. However, she said that there was not clear explanation as to why a greater proportion of patients presented with multivessel disease, compared to pre-pandemic levels. “We did see that a greater proportion of patients that presented during the pandemic with acute MI had STEMI rather than NSTEMI [Non-ST-elevation myocardial infarction], and often with STEMI we will see single-vessel disease rather than multivessel,” Talmor commented.