key: cord-0017997-qa1rlx2w
authors: Vemmou, Evangelia; Alaswad, Khaldoon; Khatri, Jaikirshan J.; Khelimskii, Dmitrii; Krestyaninov, Oleg; Poommipanit, Paul; Karacsonyi, Judit; Nikolakopoulos, Ilias; Garcia, Santiago; Brilakis, Emmanouil S.
title: Chronic Total Occlusion Percutaneous Coronary Intervention during the COVID-19 pandemic: Insights from the PROGRESS-CTO Registry
date: 2021-06-05
journal: Hellenic J Cardiol
DOI: 10.1016/j.hjc.2021.05.005
sha: 795d21e6de06c5a79e22da7caf53aeb5916f5c2b
doc_id: 17997
cord_uid: qa1rlx2w

nan

The coronavirus disease 2019 pandemic resulted in a significant decrease in percutaneous coronary interventions (PCIs) for both acute and chronic coronary syndromes (1). We analyzed the clinical, angiographic and procedural characteristics of 2,794 chronic total occlusion (CTO) PCIs performed on 2,725 patients enrolled in the PROGRESS-CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention, (clinicaltrials.gov Identifier: NCT02061436) registry and compared procedural volume and outcomes for procedures performed in 2020 vs 2019 at 21 US and international centers. Only cases from centers that enrolled patients during both years were included in the study. The study was approved by the institutional review board of each site and a waiver of informed consent was obtained.

Categorical variables were expressed as percentages and were compared using Pearson's chi-square test. Continuous variables are presented as mean ± SD or as median (interquartile range [IQR] ) and were compared using the Student's t-test and 1way analysis of variance for normally distributed variables; the Wilcoxon rank-sum was applied for nonparametric continuous variables as appropriate. All statistical analyses were performed using JMP version 13.0 (SAS Institute, Cary, North Carolina).

A total of 1,079 procedures were performed in 2020 at 22 centers as compared with 1,715 in 2019 (37.1% decrease). The majority of participating centers observed a decline in procedural volume (18 centers of 22, 81%). Mean J-CTO score was slightly higher in 2020 (2.5±1.2 vs. 2.4±1.2, p=0.0016). Technical and procedural success rates were similar, but the incidence of in-hospital major adverse cardiovascular events (MACE) was higher in 2020 (3.2% vs. 1.7%, p=0.01) ( Table) , driven by higher incidence J o u r n a l P r e -p r o o f of acute myocardial infarction (1.1% vs. 0.3% p=0.007), emergent PCI (0.5% vs. 0%, p=.005) and emergent coronary artery bypass graft surgery (0.3% vs. 0%, p=0.029).

To the best of our knowledge, this is the first study of CTO PCI volumes and outcomes during the COVID-19 pandemic showing significant decrease in procedural volumes. Technical and procedural success rates remained similar, but in-hospital MACE rates were higher in 2020, possibly because of higher angiographic complexity of CTOs treated during that year.

Our study has limitations. First, it was an observational, retrospective study.

Second, our study only reported in-hospital outcomes. Third, there was no clinical event adjudication by a clinical events committee. Fourth, all procedures were performed at high-volume, experienced PCI centers, thus limiting the generalizability of our findings to centers with limited CTO PCI experience.

In conclusion, the volume of CTO PCIs significantly decreased during the COVID-19 pandemic. Technical and procedural success rates remained stable, whereas in-hospital MACE rates increased. 

Impact of the COVID-19 Pandemic on Percutaneous Coronary Intervention in England: Insights From the British Cardiovascular Intervention Society PCI Database Cohort

Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States During COVID-19 Pandemic

Acknowledgments: Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at the Minneapolis Heart Institute Foundation (MHIF), Minneapolis, Minnesota.