key: cord-332983-d28oovm2
authors: Siudak, Zbigniew; Grygier, Marek; Wojakowski, Wojciech; Malinowski, Krzysztof P.; Witkowski, Adam; Gąsior, Mariusz; Dudek, Dariusz; Bartuś, Stanisław
title: Clinical and procedural characteristics of COVID‐19 patients treated with percutaneous coronary interventions
date: 2020-07-20
journal: Catheter Cardiovasc Interv
DOI: 10.1002/ccd.29134
sha: 
doc_id: 332983
cord_uid: d28oovm2

BACKGROUND: COVID‐19 pandemic has affected healthcare systems worldwide. Resources are being shifted and potentially jeopardize safety of non‐COVID‐19 patients with comorbidities. Our aim was to investigate the impact of national lockdown and SARS‐CoV‐2 pandemic on percutaneous treatment of coronary artery disease in Poland. METHODS: Data on patients who underwent percutaneous coronary procedures (angiography and/or percutaneous coronary intervention [PCI]) were extracted for March 13–May 13, 2020 from a national PCI database (ORPKI Registry) during the first month of national lockdown and compared with analogous time period in 2019. RESULTS: Of 163 cardiac catheterization centers in Poland, 15 (9.2%) were indefinitely or temporarily closed down due to SARS‐CoV‐2 pandemic. There were nine physicians (9 of 544; 1.7%) who were infected with SARS‐CoV‐2. There were 13,750 interventional cardiology procedures performed in Poland in the analyzed time period. In 66% of cases an acute coronary syndrome was diagnosed, and in the remaining 34% it was an elective procedure for the chronic coronary syndrome in comparison to 50% in 2019 (p < .001). There were 362 patients (2.6% of all) with COVID‐19 confirmed/suspected who were treated in interventional cardiology centers and 145 with ST‐Elevation Myocardial Infarction (STEMI) diagnosis (6% of all STEMIs). CONCLUSIONS: Due to SARS‐CoV‐2 pandemic there was an absolute reduction in the number of interventional procedures both acute and elective in comparison to 2019 and a significant shift into acute procedures. COVID‐19 confirmed/suspected patients do not differ in terms of procedural and baseline characteristics and reveal similar outcomes when treated with percutaneous coronary interventions.

Poland has had a highly efficient and widely accessible system of percutaneous treatment of coronary artery disease (CAD) with evenly distributed interventional cardiology facilities around the country and a high number of annual percutaneous coronary intervention (PCI) and primary percutaneous coronary intervention (pPCI) procedures per million inhabitants. [1] [2] [3] The distribution of cardiac catheterization centers has for many years met the requirements of ESC (European Society of Cardiology) guidelines with one cath lab for <300,000 of inhabitants. 4 The development of the hospital network system for the interventional treatment of myocardial infarction has taken over two decades to complete. 5 However, with national lockdown being implemented on March 13, 2020 following the SARS-CoV-2 pandemic and shifting resources to the treatment of only acute cases, the principal assumptions of the existing hospital network for the percutaneous treatment of CAD in Poland has been jeopardized. Moreover, by administrative decisions, entire hospitals regardless of their primary specialization are being now transformed into dedicated centers for infectious diseases, in order to accommodate COVID-19 patients. This also applies to the cardiology departments.

Our aim was to investigate based on the nationwide registry the impact of national lockdown and SARS-CoV-2 pandemic on the percutaneous treatment of CAD in Poland, as well as to provide a characteristic of COVID-19 positive or suspected patients treated in interventional cardiology centers and their immediate procedural outcomes.

The ORPKI Registry (Polish National PCI Registry) in Poland gathers data on all percutaneous diagnostic and therapeutic procedures since 2004. A detailed description of the registry and annual reports has been published previously. 1, 6 There are currently 163 catheterization laboratories in Poland reporting data for the ORPKI registry online everyday with 544 board-certified PCI operators.

For this analysis, data on all percutaneous procedures (angiography or PCI) were extracted for the two-month period (March 13-May 13, 2020). Data were gathered from the date of nationwide lockdown was administered (closed schools, nurseries, and universities, only essential workers allowed to commute to work, travel restrictions with the closing of national country borders) due to SARS-CoV2 pandemic. The recommendations for the unified proceedings with COVID-19 positive or suspected cases requiring percutaneous diagnostic and treatment have been issued by the Polish Association of Cardiovascular Interventions on March 19, 2020. 7 The ACC-SCAI recommendations were also endorsed. 8 Patients with COVID-19 suspicion (according to tho the triage recommendations of the National Institute of the Public Health and Ministry of Health) were treated as potential COVID-19 positive. The working or established diagnosis of COVID-19 was always available prior to any interventional procedure (angiography, PCI) and recorded in the web-based ORPKI database.

Swabs for molecular RT-PCR testing were obtained always before any procedure. Analysis of COVID-19 positive or suspected patients versus non-COVID patients was performed. Additionally, a comparison of contemporary two-month data versus analogous period for 2019 procedures (March 13-May 13, 2019) was carried out. Only peri-procedural outcomes and complications were recorded in the database.

All patients provided informed consent. The study complied with the ethical principles for clinical research based on the Declaration of Helsinki with later amendments. No external funding was used to support this analysis. presence of COPD (chronic obstructive pulmonary disease) and indication for the procedure. Each COVID-19 positive/suspected case was matched with 10 COVID-19 negative cases, which showed the best balance between analyzed groups. PS matching was performed using the nearest neighbor algorithm. The groups were considered balanced if standardized differences for each of the analyzed baseline/demographic characteristics were lower than 10%.

Comparison of the total amount of contrast used during the procedure, total radiation dose during procedure, and odds for death between groups after PS matching was performed using a generalized linear mixed-effects model to account for matching. Analysis was based on all cases introduced into the database within specific timeframe. Due to small number of missing data PS, matching was performed on completed cases only.

Of 163 cardiac catheterization centers in Poland, 12 (7.4%) were indefinitely closed down due to SARS-CoV-2 pandemic, and an addi- Of all patients who underwent invasive diagnostic or treatment during 2-month period, 362 (2.6%) were COVID-19 (suspected or confirmed by an approved RT-PCR test). Baseline characteristic and procedural details and outcomes of COVID-19 positive/suspected versus non-COVID-19 patients are shown in Table 1 with PS matching adjustment on outcomes in Table 2 .

There were 2,421 patients treated with pPCI for STEMI during the 2-month timeframe, of which 145 (6%) were COVID-19 (suspected or confirmed by an approved RT-PCR test). Baseline characteristic and procedural details and outcomes of COVID-19 positive/ suspected versus non-COVID-19 patients with PS matching adjustment on outcomes are shown in Tables 3 and 4 .

Best to our knowledge, this is one of the first detailed national analysis on the impact of SARS-CoV-2 pandemic on interventional cardiology procedures as well as the first presentation of baseline characteristics and immediate outcome of over 300 COVID-19 confirmed/suspected patients. Some studies and preliminary reports have suggested that a substantial decrease in interventional cardiology procedures has been observed with longer time delays to intervention, especially among STEMI COVID-19 patients 9,10 and a shift toward acute cases. 11, 12 Poland represents a high volume country for interventional cardi- Poland among moderately affected countries with over 21,000 confirmed cases so far and over 1,000 deaths with governmental lockdown measures being implemented early on. 13 Yet, the negative impact on the healthcare system seems substantial. The shift toward acute cases (ACS) is evident, but what raises even more concern is an almost 40% decrease in the absolute number of interventional proce- quences of these events in the near future mainly as an increase of heart failure incidence and hospitalizations.

The chance to perform interventional procedure in a COVID-19

confirmed/suspected case is 1 in 39 in general or 1 in 17 when dealing with STEMI patients in Poland and the risk of becoming infected as a PCI operator is currently 1.7% per 2 months and seems low but that numbers will certainly vary in the end.

It is vital to provide recommendations on a national/international level for the management of COVID-19 and non-COVID-19 patients;

however, these days, this might not be the case anymore since anyone may be infected. Therefore, cathlab staff needs to adhere to the new reality that will probably stay with us for months if not years and considering The study has limitations which include the lack of further followup of patients beyond catheterization room and the analysis represents only situation in one country (Poland) which may not be universal due to various presentation of SARS-CoV-2 pandemic worldwide.

The 

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The authors declare no conflict of interest.

https://orcid.org/0000-0002-8033-3977