Cardiac catheterizations declined during COVID-19 surge at New York center
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In a single-center analysis, cardiac catheterization procedures decreased during a 6-week period of the COVID-19 lockdown compared with the same span in 2019, researchers reported.
However, outcomes not attributed to COVID-19 were no different during the lockdown compared with the year before at Montefiore Medical Center in Bronx, New York, according to the researchers.
“We hypothesized that the COVID-19 pandemic postponed patients’ decision to seek hospital medical attention, leading to increased cardiovascular-related mortality and infrequent cardiovascular complications,” Cristina Sanina, MD, clinical fellow in cardiology at Montefiore Medical Center and Albert Einstein College of Medicine, said during a presentation at the virtual American Heart Association Scientific Sessions.
On March 7, elective procedures, including coronary angiography and angioplasty, were uniformly canceled due to the pandemic, she said.
The researchers conducted a retrospective observational study examining the incidence, prevalence, complication rates and mortality from CV among individuals who were hospitalized at Montefiore during this period. Outcomes that underwent analysis included STEMI, non-STEMI, stroke and congestive HF.
Data for patients admitted from March 7 to April 21 were compared with findings for patients hospitalized during the same period in 2019.
Baseline data showed that significantly more men were admitted during the COVID period. Also, patients from 2020 had significantly less hypertension, atrial fibrillation and congestive HF and used significantly fewer beta-blockers or ACE inhibitors compared with those from 2019.
Results showed a significant decrease in incidence of the outcomes of interest overall (P < .05) for the period in 2020.
Cardiac catheterization procedures for non-STEMI decreased from 37 in 2019 to nine in 2020 (P = .002).
“We treated a very small number of patients with non-STEMI in 2020,” Sanina said. Importantly, the mortality rates for non-STEMI were 0% in both 2019 and 2020.
Similarly, 58 patients were treated with cardiac catheterization for congestive HF in 2019, whereas just 18 underwent this procedure in 2020 (P < .0001).
“More patients were admitted in 2020 for systolic heart failure and not diastolic,” Sanina said.
The mortality rate from HF in 2020 was 22%, according to Sanina. “It was an extremely high rate,” she said.
Other findings showed that stroke hospitalization also decreased between the 6-week period of interest in 2019 and that same period in 2020 (P = .027). “We have a lot of strokes in the Bronx,” Sanina said. “In-hospital mortality for stroke was significantly higher in 2020 than it was for 2019.”
However, STEMI admissions did not change significantly during the pandemic from 2019, down from 43 to 33 (P = .16). “There was a trend to decrease,” Sanina said. “Most importantly is that all the patients who presented with STEMI had similar in-hospital mortality rates in 2020 compared to 2019.”
Patients hospitalized for STEMI in 2020 demonstrated higher troponin T levels at presentation (P < .05), suggesting delayed admission, according to the findings. Wall motion abnormalities and left ventricular ejection fraction less than 50% (P < .05) also were observed more frequently in the 2020 patient group.
“Despite all the stress of the COVID-19 pandemic, the outcomes of acute cardiovascular syndromes were essentially no different in 2020 compared with 2019, except for an increase in heart failure and stroke in-hospital mortality, which we associated with COVID-19 infection,” Sanina said. “We believe that all patients who were hospitalized with acute cardiovascular syndromes did well when they came to the hospital on time.”
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Sanina C, et al. Abstract #401. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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