You are here

Article Text

Article menu

Download PDFPDF

Interventional cardiology
Original research
COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group
  1. Callum D Little1,2,
  2. Tushar Kotecha1,
  3. Luciano Candilio1,
  4. Richard J Jabbour3,
  5. George B Collins4,
  6. Asrar Ahmed5,
  7. Michelle Connolly6,
  8. Ritesh Kanyal7,
  9. Ozan M Demir8,
  10. Lucy O Lawson1,
  11. Brian Wang3,
  12. Sam Firoozi6,
  13. James C Spratt6,
  14. Divaka Perera8,
  15. Philip MacCarthy7,
  16. Miles Dalby5,
  17. Ajay Jain4,
  18. Simon J Wilson6,
  19. Iqbal Malik3 and
  20. Roby Rakhit1,2
  1. 1Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
  2. 2Institute of Cardiovascular Science, University College London, London, United Kingdom
  3. 3Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
  4. 4Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
  5. 5Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
  6. 6Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
  7. 7Department of Cardiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
  8. 8Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
  1. Correspondence to Dr Callum D Little; callumlittle{at}nhs.net

Abstract

Objectives To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.

Methods We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes

Results There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62–118) min in 2020 vs 75 (57–95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34–65) min in 2020 vs 48 (35–70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3–9) days vs 3 (2–4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.

Conclusion These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.

  • percutaneous coronary intervention
  • acute coronary syndrome
  • chest pain
  • myocardial infarction
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/openhrt-2020-001432

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @callumlittle6, @DrOzanDemir

    • Collaborators Niket Patel, Sundeep S Kalra, Deven Patel, Tim Lockie, Gerry Coghlan, Elliot Smith, Gavin Manmathan, M Curtis and S Cashin.

    • Contributors CDL, TK, LC and RR cowrote the paper. RJJ, GBC, AA, MC, RK, OMD, LOL and BW contributed to data collection at participating hospitals. SF, JCS, DP, PM, MD, AJ, SJW and IM provided oversight and quality control of data from participating hospitals. All authors approved the final manuscript.

    • Funding This work was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. CDL and RDR gratefully acknowledge funding from the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS)(203145Z/16/Z).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval All patient identifiable information was removed before database merging and analysis. The audit was registered with the hospital audit departments at each centre. Because this analysis was performed on anonymised data from mandatory audit, the local research ethics committee advised that formal ethical approval was not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Deidentified participant data are available upon reasonable request. Please contact Callum D Little at callumlittle@nhs.net