PCI utilization decreased but rebounded quickly during pandemic
Click Here to Manage Email Alerts
Key takeaways:
- PCI volume dropped considerably during the first quarter of the pandemic.
- Quarterly volumes rebounded to more than 90% of pre-pandemic mean by second quarter 2021. PCI volume for STEMI was stable throughout.
Registry data revealed large decreases in the utilization of PCI during the COVID‐19 pandemic, which rebounded quickly by mid-2021.
The number of patients with a COVID‐19 history who underwent PCI increased steadily during the pandemic, researchers reported.
Image: Adobe Stock
In an analysis of the New York State PCI registry, researchers also found that among patients who underwent PCI, those with COVID‐19 accompanied by acute respiratory distress syndrome (ARDS) were at much higher risk for short‐term mortality than patients who never had COVID‐19; however, COVID‐19 without ARDS and history of COVID‐19 were not associated with higher mortality for patients who had PCI as of the second quarter of 2021.
“There was a large decrease in the utilization of PCI during the COVID-19 period, particularly among elective patients, but the volume rebounded quickly and was nearly at pre-COVID levels by the second quarter of 2021,” Edward L. Hannan, PhD, MS, MS, FACC, distinguished professor emeritus at the University at Albany School of Public Health and a principal investigator at the New York State Department of Health Cardiac Services Program, told Healio. “Very few patients with COVID-19 underwent PCI during the height of the COVID epidemic, but COVID-19 patients with ARDS who underwent PCI had very elevated mortality rates. Also, the percentage of PCI patients with a history of COVID-19 increased considerably during the COVID period, and these patients did not have an elevated in-hospital mortality rate.”
Hannan and colleagues used New York State’s PCI registry to assess the utilization of PCI and the presence of COVID‐19 in four patient subgroups ranging in severity from STEMI to elective patients before (December 2018-February 2020) and during the COVID‐19 era (March 2020-May 2021), as well as to examine the impact of different COVID-19 severity levels on the mortality of different types of PCI patients. COVID-19 status was defined as no COVID‐19/never had COVID‐19; current COVID‐19 without ARDS; current COVID‐19 with ARDS and intubated; current COVID‐19 with ARDS and intubated/not intubated due to a do-not-resuscitate/intubate status; and history of COVID‐19 before the index admission.
The findings were published in Catheterization and Cardiovascular Interventions.
Overall PCI quarterly volume, which averaged 13,446 (6.9 per 100,000 per quarter) in the five quarters preceding the pandemic, decreased to 7,381 (3.7 per 100,000), a 46% decrease, in the second quarter of 2020. PCI quarterly volume then rose to 11,620 in the following quarter and was at 13,248 by the second quarter of 2021, which was 99% of the pre‐COVID quarterly mean of 13,880.
Researchers observed that decreases in the mean quarterly PCI volume from the pre-pandemic period through the first quarter of the pandemic ranged from 20% for patients with STEMI to 61% for elective patients, with the other two subgroups having decreases in between these values.
“It is also notable that the percentage of admissions for STEMI who underwent PCI was fairly stable during the pre-pandemic and pandemic periods, ranging from 78% (first quarter of 2019, first quarter of 2020, fourth quarter of 2020, first quarter of 2021) to 82% (third quarter of 2019, fourth quarter of 2019),” the researchers wrote.
PCI quarterly volume rebounds from the pre-pandemic period to the second quarter of 2021 were in excess of 90% for all patient subgroups and 99.7% for elective patients. Existing COVID‐19 was rare among PCI patients, ranging from 1.74% for patients with STEMI to 3.66% for elective patients.
Very few patients undergoing PCI had COVID‐19 accompanied by ARDS who were intubated or had do-not-resuscitate/intubate orders (n = 53); however, these patients had the highest observed in‐hospital mortality rate (56.6%), according to the researchers. This was followed by the 38 patients with COVID‐19 accompanied by ARDS who were not intubated, who had an 18.4% mortality rate. The risk-adjusted ORs for mortality for these two groups compared with patients who never had COVID-19 were 24.53 (95% CI, 12.06-49.88) and 10.81 (95% CI, 4.39-26.63), respectively.
“Moving forward, it will be important to see if PCI patients with a history of COVID-19 do have an elevated short-term and longer-term mortality than other patients, especially in view of the dangers of long COVID,” Hannan told Healio.
For more information:
Edward L. Hannan, PhD, MS, MS, FACC, can be reached at edward.hannan@health.ny.gov.
Collapse
Click Here to Manage Email Alerts