Impact of the COVID-19 pandemic on coronary invasive procedures at two Italian high-volume referral centers

Abstract

Aims The purpose of this study was to verify the impact on the number and characteristics of coronary invasive procedures for acute coronary syndrome (ACS) of two hub centers with cardiac catheterization facilities, during the first month of lockdown following the COVID-19 pandemic. Materials and methods Procedural data of ACS patients admitted between 10 March and 10 April 2020 were compared with those of the same period of 2019. Results We observed a 23.4% reduction in ACS admissions during 2020, with a decrease for both ST-elevation myocardial infarction (STEMI) (–5.6%) and non-ST-elevation myocardial infarction (–34.5%), albeit not statistically significant (P = 0.2). During the first 15 days of the examined periods, the reduction in ACS admissions reached 52.5% (–25% for STEMI and –70.3% for non-ST-elevation myocardial infarction, P = 0.04). Among STEMI patients, the rate of those with a time delay from symptoms onset longer than 180 min was significantly higher during the lockdown period (P = 0.01). Radiograph exposure (P = 0.01) was higher in STEMI patients treated in 2020 with a slightly higher amount of contrast medium (P = 0.1) and number of stents implanted (P = 0.1), whereas the number of treated vessels was reduced (P = 0.03). Percutaneous coronary intervention procedural success and in-hospital mortality were not different between the two groups and in STEMI patients (P NS for all). Conclusion During the early phase, the COVID-19 outbreak was associated with a lower rate of admissions for ACS, with a substantial impact on the time delay presentation of STEMI patients, but apparently without affecting the in-hospital outcomes.

Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device

“…As a consequence of the disruptive effects of COVID-19 pandemic, screening for AF may become even more important in the next future. Indeed, COVID-19 caused a polarization of care on the various manifestation of SARS-CoV-2 infection and on its management [39][40][41] that coupled with the fear and psychological distress diffused within the population [42][43][44][45] led to a marked reduction in access to Emergency Departments for acute cardiovascular conditions, including new-onset AF [46][47][48][49][50]. Some data from large datasets indicate that the risk of undiagnosed AF during COVID-19 lockdown is associated with an increased occurrence of stroke, related to lack of anticoagulation in patients at risk [48], thus making of great clinical value any initiatives of opportunistic screening for detecting unknown and previously undetected AF.…”

The Global Effect of the COVID-19 Pandemic on STEMI Care: A Systematic Review and Meta-analysis

“…A total of 32 studies met our inclusion criteria. Four studies each originated from China, 4,24,32,33 Italy, 20,[34][35][36] and North America, [37][38][39][40] 3 each from France [41][42][43] and Turkey, [44][45][46] 2 from the United Kingdom, 47,48 and 1 each from Austria, 49 Belgium, 50 Egypt, 51 Iran, 52 Israel, 53 Japan, 54 Pakistan, 55 Poland, 56 Singapore, 23 Spain, 57 and Switzerland. 60 One study was a multicentred cohort study of various databases belonging to different European countries.…”

Impact of COVID-19 Pandemic on Remote Monitoring of Cardiac Implantable Electronic Devices in Italy: Results of a Survey Promoted by AIAC (Italian Association of Arrhythmology and Cardiac Pacing)

“…During the recent COVID-19 outbreak, Italian health authorities mandated to replace in-person outpatient activities with remote evaluations [23,24]. Although this strategy aimed to minimise the risk of infection [25], the implications for the health of patients with cardiovascular diseases may potentially be unfavourable [26][27][28].…”