National survey of percutaneous coronary intervention during the COVID-19 pandemic in Japan: second report of the Japanese Association of Cardiovascular Intervention and Therapeutics

Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study

BACKGROUND

The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays.

OBJECTIVES

This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity.

METHODS

This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses.

RESULTS

We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (-52%; P = 0.001), Central-South America (-33%; P < 0.001), and Asia (-29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity.

CONCLUSIONS

TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.

Cardiovascular considerations during the COVID-19 pandemic: A focused review for practice in Japan

The COVID-19 pandemic is continuing to have drastic consequences for patients, healthcare workers, and the health system. Its cardiovascular implications have been well described in previous studies, but original reports from Japan are sparse. Validating overseas findings in the Japanese clinical settings is crucial to improve local COVID-19 care and to clarify the pandemic's impacts in the country. This review of available literature demonstrates that in Japanese patients and clinical settings too, there is a close relationship between COVID-19 and the cardiovascular system including cardiovascular complications. On the contrary, secondary effects on cardiovascular practice including service disruptions, telemedicine, and epidemiological changes in Japan have been relatively small.

Cardiovascular events and atherosclerosis in patients with type 2 diabetes and impaired glucose tolerance -What are the medical treatments to prevent cardiovascular events in such patients?

Type 2 diabetes mellitus (T2DM) and impaired glucose tolerance (IGT) significantly induce advanced coronary artery disease and systemic atherosclerosis. Thus, T2DM and IGT are traditional risk factors of cardiovascular disease (CVD). On the other hand, acute coronary syndrome is frequently caused by the rupture of coronary atherosclerotic plaques, which reduces patients' quality of life and may result in death. To date, many trials have sought to identify ways to determine the coronary plaque volume and its vulnerability, and many studies have demonstrated that some specific antihyperglycemic agents may prevent coronary or carotid plaque progression, decrease plaque volume, induce plaque stability, and improve clinical outcomes in patients with T2DM and IGT. This article reviews i) the association between coronary or carotid plaques and abnormal glucose tolerance, including T2DM; and ii) the effects of oral antihyperglycemic drugs to improve clinical outcomes and stabilize atherosclerotic plaques in patients with T2DM and IGT.

Transcatheter aspiration of a thrombus and percutaneous transluminal coronary recanalization for ST-segment elevation myocardial infarction related to coronavirus disease 2019

Although the novel coronavirus disease 2019 (COVID-19) causes severe viral pneumonia, it has also been reported, in some cases, to co-exist with ST-segment elevation myocardial infarction. Here, we describe the case of a patient with COVID-19 and coronary risk factors for hypertension, including smoking and obesity, who developed acute myocardial infarction due to primary coronary artery thrombosis and was treated with transcatheter thrombus aspiration and percutaneous transluminal coronary recanalization (PTCR) with intracoronary urokinase administration. A large volume of thrombus was collected and thrombolysis in myocardial infarction flow grade 3 was obtained after the procedures. PTCR with or without transcatheter thrombus aspiration may be a useful treatment option.

<Learning objective: ST-segment elevation myocardial infarction is a critical complication in patients with novel coronavirus disease 2019. Patients need emergent recanalization to prevent development of fatal cardiac events.>