Chun Shing Kwok1,2, Chris P Gale3,4,5, Nick Curzen6, Mark A de Belder7, Peter Ludman8, Thomas F Lüscher9,10, Evangelos Kontopantelis11, Chris Roebuck12, Tom Denwood12, Tony Burton12, Julian Hains7, John E Deanfield7,13, Mamas A Mamas1,2. 1. Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.). 2. Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.). 3. Leeds Institute of Cardiovascular and Metabolic Medicine (C.P.G.), University of Leeds, United Kingdom. 4. Leeds Institute for Data Analytics (C.P.G.), University of Leeds, United Kingdom. 5. Department of Cardiology, Leeds Teaching Hospitals NHS Trust, United Kingdom (C.P.G.). 6. Wessex Cardiothoracic Unit, Southampton University Hospital Southampton & Faculty of Medicine University of Southampton, United Kingdom (N.C.). 7. National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (M.A.d.B., J.H., J.E.D.). 8. Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (P.L.). 9. Royal Brompton and Harefield Hospital Trust, Imperial College London, United Kingdom (T.F.L.). 10. Centre for Molecular Cardiology, University of Zurich, Switzerland (T.F.L.). 11. Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, United Kingdom (E.K.). 12. NHS Digital, Leeds, United Kingdom (C.R., T.D., T.B.). 13. Department of Cardiology, Great Ormond Street Hospital, University College London, United Kingdom (J.E.D.).
Abstract
BACKGROUND: The objective of the study was to evaluate changes in percutaneous coronary intervention (PCI) practice in England by analyzing procedural numbers, changes in the clinical presentation, and characteristics of patients and their clinical outcomes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study of all patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society database. RESULTS: Forty-four hospitals reported PCI procedures for 126 491 patients. There were ≈700 procedures performed each week before the lockdown. After the March 23, 2020 lockdown (11th/12th week in 2020), there was a 49% fall in the number of PCI procedures after the 12th week in 2020. The decrease was greatest in PCI procedures performed for stable angina (66%), followed by non-ST-segment-elevation myocardial infarction (45%), and ST-segment-elevation myocardial infarction (33%). Patients after the lockdown were younger (64.5 versus 65.5 years, P<0.001) and less likely to have diabetes (20.4% versus 24.6%, P<0.001), hypertension (52.0% versus 56.8%, P=0.001), previous myocardial infarction (23.5% versus 26.7%, P=0.008), previous PCI (24.3% versus 28.3%, P=0.001), or previous coronary artery bypass graft (4.6% versus 7.2%, P<0.001) compared with before the lockdown. CONCLUSIONS: The lockdown in England has resulted in a significant decline in PCI procedures. Fewer patients underwent PCI for stable angina. This enabled greater capacity for urgent and emergency cases, and a reduced length of stay was seen for such patients. Significant changes in the characteristics of patients towards a lower risk phenotype were observed, particularly for non-ST-segment-elevation myocardial infarction, reflecting a more conservative approach to this cohort.
BACKGROUND: The objective of the study was to evaluate changes in percutaneous coronary intervention (PCI) practice in England by analyzing procedural numbers, changes in the clinical presentation, and characteristics of patients and their clinical outcomes during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study of all patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society database. RESULTS: Forty-four hospitals reported PCI procedures for 126 491 patients. There were ≈700 procedures performed each week before the lockdown. After the March 23, 2020 lockdown (11th/12th week in 2020), there was a 49% fall in the number of PCI procedures after the 12th week in 2020. The decrease was greatest in PCI procedures performed for stable angina (66%), followed by non-ST-segment-elevation myocardial infarction (45%), and ST-segment-elevation myocardial infarction (33%). Patients after the lockdown were younger (64.5 versus 65.5 years, P<0.001) and less likely to have diabetes (20.4% versus 24.6%, P<0.001), hypertension (52.0% versus 56.8%, P=0.001), previous myocardial infarction (23.5% versus 26.7%, P=0.008), previous PCI (24.3% versus 28.3%, P=0.001), or previous coronary artery bypass graft (4.6% versus 7.2%, P<0.001) compared with before the lockdown. CONCLUSIONS: The lockdown in England has resulted in a significant decline in PCI procedures. Fewer patients underwent PCI for stable angina. This enabled greater capacity for urgent and emergency cases, and a reduced length of stay was seen for such patients. Significant changes in the characteristics of patients towards a lower risk phenotype were observed, particularly for non-ST-segment-elevation myocardial infarction, reflecting a more conservative approach to this cohort.
Authors: Matthew T Mefford; Jaejin An; Nigel Gupta; Teresa N Harrison; Steven J Jacobsen; Ming-Sum Lee; Paul Muntner; Chileshe Nkonde-Price; Lei Qian; Kristi Reynolds Journal: Perm J Date: 2021-12-13
Authors: Thomas A Kite; Andrew Ladwiniec; Colum G Owens; Alexander Chase; Aadil Shaukat; Abdul M Mozid; Peter O'Kane; Helen Routledge; Divaka Perera; Ajay K Jain; Nick Palmer; Stephen P Hoole; Mohaned Egred; Manas K Sinha; Thomas J Cahill; Luciano Candilio; Brijesh Anantharam; Jonathan Byrne; Simon J Walsh; Margaret McEntegart; Sharon Kean; Laraib Siddique; Charley Budgeon; Nick Curzen; Colin Berry; Peter Ludman; Anthony H Gershlick Journal: Catheter Cardiovasc Interv Date: 2021-05-04 Impact factor: 2.585
Authors: Thomas A Kite; Amerjeet S Banning; Andrew Ladwiniec; Chris P Gale; John P Greenwood; Miles Dalby; Rachel Hobson; Shaun Barber; Emma Parker; Colin Berry; Marcus D Flather; Nick Curzen; Adrian P Banning; Gerry P McCann; Anthony H Gershlick Journal: BMJ Open Date: 2022-05-03 Impact factor: 3.006
Authors: Niall Patrick Connolly; Andrew Simpkin; Darren Mylotte; James Crowley; Stephen O'Connor; Khalid AlHarbi; Thomas Kiernan; Sacchin Arockiam; Patrick Owens; Amal John; Gavin J Blake; Sean Fitzgerald; Diarmaid Cadogan; Liesbeth Rosseel Journal: BMJ Open Date: 2021-04-02 Impact factor: 2.692
Authors: Mats de Lange; Ana Sofia Carvalho; Óscar Brito Fernandes; Hester Lingsma; Niek Klazinga; Dionne Kringos Journal: Int J Environ Res Public Health Date: 2022-03-08 Impact factor: 3.390