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Lunardi M, Mamas MA, Mauri J, Molina CM, Rodriguez-Leor O, Eggington S, Pietzsch JB, Papo NL, Walleser-Autiero S, Baumbach A, Maisano F, Ribichini FL, Mylotte D, Barbato E, Piek JJ, Wijns W, Naber CK. Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:25-35. [PMID: 37286294 DOI: 10.1093/ehjqcco/qcad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
AIMS As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications.This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. METHODS AND RESULTS Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group.STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49 332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (-1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. CONCLUSION The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
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Affiliation(s)
- Mattia Lunardi
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Mamas A Mamas
- Keele Cardiovascular Research, Keele University, Stoke on Trent, UK
| | - Josepa Mauri
- Gerència de Processos Integrats de Salut. Àrea Assistencial. Servei Català de la Salut. Generalitat de Catalunya, Barcelona, Spain
- Institut del Cor, Hospital Universiari Germans Trias i Pujol, Badalona, Spain
| | - Carmen Medina Molina
- Registry of Myocardial Infarction, Catalan Health Service, Catalunyia, Barcelona, Spain
| | | | - Simon Eggington
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | | | - Natalie L Papo
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Silke Walleser-Autiero
- Health Economics, Policy and Reimbursement, Medtronic International Trading Sarl, Tolochenaz, Switzerland
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
| | - Francesco Maisano
- Valve Center OSR, Cardiac Surgery IRCCS San Raffaele Hospital, Vita Salute University UniSR, Milano, Italy
| | | | - Darren Mylotte
- Galway University Hospital, SAOLTA Healthcare Group and University of Galway, Galway, Ireland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa, Roma, Italy
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef, Amsterdam, the Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Ireland
| | - Christoph K Naber
- Department of Internal Medicine I, Cardiology and Intensive Care, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
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Sato H, Yonezu K, Saito S, Abe I, Tawara K, Akioka H, Shinohara T, Teshima Y, Yufu K, Abe R, Takahashi N. Impact of the COVID-19 Pandemic on the Long-Term Prognosis of Acute Myocardial Infarction in Japan. Cureus 2024; 16:e51905. [PMID: 38333491 PMCID: PMC10850441 DOI: 10.7759/cureus.51905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Background During the early phase of the coronavirus disease 2019 (COVID-19) pandemic, a global reduction in hospitalizations for acute myocardial infarction (AMI) was observed. Generally, patients experienced increased severity of AMI with delays in time from symptom onset to treatment during the pandemic. However, the impact of the COVID-19 pandemic on in-hospital mortality among patients with AMI remains unclear. This study aimed to compare the long-term prognosis of patients with AMI during the COVID-19 pandemic to that observed in the pre-pandemic period and to evaluate the influence of the COVID-19 pandemic on the prognosis of patients with AMI. Methods We reviewed the data of patients admitted to our hospital for AMI treatment between April 1, 2018, and March 31, 2021. The time from admission to major adverse cardiac events (MACE), as well as the time from admission to all-cause death, were examined between the pandemic period (April 1, 2020, to March 31, 2021) and the pre-pandemic period (April 1, 2018, to March 31, 2020). Results Eighty patients were included in the study, and those admitted during the pandemic exhibited a higher likelihood of advanced age, lower levels of LDL-cholesterol, and a reduced prevalence of hypertension. The 2.5-year MACE-free survival and overall survival rates between the patients during the pre-pandemic and pandemic periods were not significantly different. Conclusion The long-term prognosis of patients with AMI during the COVID-19 pandemic remains unclear. In this study, we reported that the 2.5-year MACE-free survival and overall survival rates of the patients with AMI admitted during the COVID-19 pandemic were not significantly different from those during the pre-pandemic period. The impact of the COVID-19 pandemic on the prognosis of patients with AMI appears to vary according to the study population.
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Affiliation(s)
- Hiroki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, JPN
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
| | - Shotaro Saito
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, JPN
| | - Ichitaro Abe
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, JPN
| | - Katsunori Tawara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, JPN
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, JPN
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
| | - Ryuzo Abe
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, JPN
- Department of Emergency Medicine, Faculty of Medicine, Oita University, Oita, JPN
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Oita, JPN
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3
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Muhyieddeen A, Cheng S, Mamas MA, Beasley D, Weins GC, Gulati M. Racial Disparities in Mortality Associated With Acute Myocardial Infarction and COVID-19 in the United States: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101798. [PMID: 37178989 PMCID: PMC10174333 DOI: 10.1016/j.cpcardiol.2023.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
This study assessed the COVID-19 pandemic's impact on racial disparities in acute myocardial infarction (AMI) management and outcomes. We reviewed AMI patient management and outcomes in the pandemic's initial nine months, comparing COVID-19 and non-COVID-19 cases using 2020's National Inpatient Sample data. Our findings revealed that patients with concurrent AMI and COVID-19 had higher in-hospital mortality (aOR 3.19, 95% CI 2.63-3.88), increased mechanical ventilation (aOR 1.90, 95% CI 1.54-2.33), and higher initiation of hemodialysis (aOR 1.38, 95% CI 1.05-1.89) compared to those without COVID-19. Moreover, Black and Asian/Pacific Islander patients had higher in-hospital mortality than White patients, (aOR 2.13, 95% CI 1.35-3.59; aOR 3.41, 95% CI 1.5-8.37). Also, Black, Hispanic, and Asian/Pacific Islander patients showed higher odds of initiating hemodialysis (aOR 5.48, 95% CI 2.13-14.1; aOR 2.99, 95% CI 1.13-7.97; aOR 7.84, 95% CI 1.55-39.5), and were less likely to receive PCI for AMI (aOR 0.71, 95% CI 0.67-0.74; aOR 0.81, 95% CI 0.77-0.86; aOR 0.82, 95% CI 0.75-0.90). Black patients also showed less likelihood of undergoing CABG (aOR 0.55, 95% CI 0.49-0.61). Our study highlights elevated mortality and complications in COVID-19 AMI patients, emphasizing significant racial disparities. These findings underscore the pressing need for initiatives addressing healthcare disparities, enhancing access, and promoting culturally sensitive care to boost health equity.
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Affiliation(s)
- Amer Muhyieddeen
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Susan Cheng
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA
| | - Mamas A Mamas
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | | | - Galen Cook Weins
- Bioststatistics and Bioinformatics Research Center, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, CA.
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Suzuki T, Fujino M, Murai K, Iwai T, Sawada K, Matama H, Miura H, Honda S, Yoneda S, Takagi K, Otsuka F, Asaumi Y, Kataoka Y, Tahara Y, Ogata S, Nishimura K, Tsujita K, Noguchi T. Urinary catheterization prior to PCI worsens clinical outcomes in patients with acute myocardial infarction. J Cardiol 2023; 81:373-377. [PMID: 36565996 DOI: 10.1016/j.jjcc.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Indwelling urethral catheters (IUCs) are used to measure urine volume, keep patients on bed rest, or keep the groin area clean in patients with acute myocardial infarction (AMI). However, the association between IUC use and in-hospital urinary-related complications is unknown. METHODS This was a single-center retrospective analysis of 303 patients admitted to our hospital in 2018-2020 who had AMI without cardiogenic shock. An IUC was inserted in the emergency room upon initiation of invasive catheter treatment and removed as soon as possible. The primary outcome was in-hospital adverse urinary event (IHAUE), which consisted of in-hospital urinary tract infection and in-hospital gross hematuria. RESULTS Of 303 patients, 243 patients (80.2 %) underwent IUC insertion. A lower proportion of patients with IUCs were male (72 % vs. 85 %, p = 0.044). A higher proportion had Killip classification 2 or 3 (13 % vs. 0 %, p = 0.003) or ST-elevation myocardial infarction (65 % vs. 32 %, p < 0.001). IHAUEs occurred significantly more commonly in patients with IUCs than without IUCs (11 % vs. 2 %, p = 0.023). Kaplan-Meier analysis showed that IHAUEs occurred more frequently in patients with IUCs than patients without IUCs (log-rank test p = 0.033). Furthermore, IUC use longer than the median of 2 days was associated with a higher odds ratio (OR) for IHAUE when compared with those without IUC use (OR, 3.65; 95 % confidence interval, 1.28-10.4; p = 0.015). There were no significant differences in in-hospital mortality by IUC status. CONCLUSIONS IUC use is associated with a higher risk of IHAUEs in patients with uncomplicated AMI. Routine IUC use might not be recommended.
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Affiliation(s)
- Toshiaki Suzuki
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan.
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Clinical Research and Development, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Clinical Research and Development, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Ali A, Schirmer T, Kiernan FJ, Piccirillo B, Ingrassia J, Azemi T, Sadiq I, Fram DB, Rizvi A, Joshi S, Mather J, McKay RG. Recovery From the Impact of COVID-19 on Treatment Times and Clinical Outcomes of Patients With ST-Segment Elevation Myocardial Infarction: An Interim Analysis. Tex Heart Inst J 2023; 50:491449. [PMID: 36913275 PMCID: PMC10178640 DOI: 10.14503/thij-22-7919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Previous studies have documented a negative impact of the COVID-19 pandemic on emergent percutaneous treatment of patients with ST-segment elevation myocardial infarction (STEMI), but few have examined recovery of healthcare systems in restoring prepandemic STEMI care. METHODS Retrospective analysis was performed of data from 789 patients with STEMI from a large tertiary medical center treated with percutaneous coronary intervention between January 1, 2019, and December 31, 2021. RESULTS For patients with STEMI presenting to the emergency department, median time from door to balloon was 37 minutes in 2019, 53 minutes in 2020, and 48 minutes in 2021 (P < .001), whereas median time from first medical contact to device changed from 70 to 82 to 75 minutes, respectively (P = .002). Treatment time changes in 2020 and 2021 correlated with median emergency department evaluation time (30 to 41 to 22 minutes, respectively; P = .001) but not median catheterization laboratory revascularization time. For transfer patients, median time from first medical contact to device changed from 110 to 133 to 118 minutes, respectively (P = .005). In 2020 and 2021, patients with STEMI had greater late presentation (P = .028) and late mechanical complications (P = .021), with nonsignificant increases in yearly in-hospital mortality (3.6% to 5.2% to 6.4%; P = .352). CONCLUSION COVID-19 was associated with worsening STEMI treatment times and outcomes in 2020. Despite improving treatment times in 2021, in-hospital mortality had not decreased in the setting of a persistent increase in late patient presentation and associated STEMI complications.
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Affiliation(s)
- Abdelrahman Ali
- Division of Hospital Medicine, Hartford Hospital, Hartford, Connecticut
| | - Thomas Schirmer
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | | | - Bryan Piccirillo
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Joseph Ingrassia
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Talhat Azemi
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Immad Sadiq
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Daniel B Fram
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Asad Rizvi
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Saurabh Joshi
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Jeffrey Mather
- Division of Research Administration, Hartford Hospital, Hartford, Connecticut
| | - Raymond G McKay
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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6
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Di Lisi D, Madaudo C, Di Fazio L, Gulotta A, Triolo OF, Galassi AR, Incorvaia L, Russo A, Novo G. Higher Incidence of Cancer Therapy-Related Cardiac Dysfunction in the COVID-19 Era: A Single Cardio-Oncology Center Experience. J Cardiovasc Dev Dis 2023; 10:jcdd10010023. [PMID: 36661918 PMCID: PMC9861046 DOI: 10.3390/jcdd10010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/09/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
AIM COVID-19 pandemic had a big impact on our life, it has revolutionized the practice of cardiology and the organization of hospital and outpatient activities. Thus the aim of our study was to assess the impact of the COVID-19 pandemic on the development of cancer therapy-related cardiac dysfunction (CTRCD). METHODS AND RESULTS A single center retrospective study was carried out evaluating 96 cancer patients treated with anthracyclines and admitted to our Cardio-Oncology unit from June to August 2019 and 60 patients from June to August 2021. The incidence of CTRCD was assessed performing an echocardiogram at the time of the enrollment. We found a significantly higher incidence of CTRCD in the second period compared to first period (13% vs. 2%, p value 0.0058). In addition we found that fewer yearly visits were performed in our Cardio-oncology unit in 2021 compared to 2019 (300 patients/year in 2019 vs. 144 patients/year in the COVID era). CONCLUSION COVID-19 pandemic seems to influence the onset of CTRCD in cancer patients by indirectly reducing hospital access of cancer patients and cardiological checks. In addition our data reflect the impact of the COVID-19 pandemic in the late diagnosis of cancer, in the reduction of hospital admissions and regular medical checks, in the increase of comorbidities and cardiovascular complications.
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Affiliation(s)
- Daniela Di Lisi
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-3891-987-348
| | - Cristina Madaudo
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Luca Di Fazio
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Antonino Gulotta
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Oreste Fabio Triolo
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Alfredo Ruggero Galassi
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Lorena Incorvaia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital Paolo Giaccone, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
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7
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Arnaoutakis GJ, Wallen TJ, Desai N, Martin TD, Thourani VH, Badhwar V, Wegerman ZK, Young R, Grau-Sepulveda M, Zwischenberger B, Beaver TM, Jacobs JP, Sultan I. Outcomes of acute type A aortic dissection during the COVID-19 pandemic: An analysis of the Society of Thoracic Surgeons Database. J Card Surg 2022; 37:4545-4551. [PMID: 36378930 DOI: 10.1111/jocs.17085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID-19 pandemic. This study examined presentation patterns and outcomes of ATAAD in North America immediately before, and during, the COVID-19 pandemic. METHODS The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was queried to identify patients presenting with ATAAD in the 12 months pre-pandemic (March 2019-February 2020), and during the early pandemic (March through June 2020). Demographics and operative characteristics were compared using χ² test and Wilcoxon Rank-sum test. The median annual case volume designated low-volume centers versus high-volume centers (>10 cases per month). Step-wise variable selection was used to create a risk set used for adjustment of all multivariable models. RESULTS There were 5480 patients identified: 4346 pre-pandemic and 1134 during pandemic. There was significantly lower volume of median cases per month during the COVID-19 pandemic period (286 interquartile range [IQR]: 256-306 vs. 372 IQR: 291-433,p = .0152). In historically low-volume centers (<10 cases per year), there was no difference in volume between the two periods (142 IQR: 133-166 vs. 177 IQR: 139-209, p = NS). In high-volume centers, there was a decline during the pandemic (140 IQR: 123-148 vs. 212 IQR: 148-224, p = .0052). There was no difference in overall hospital-to-hospital transfers during the two time periods (54% of cases pre-pandemic, 55% during). Patient demographics, operative characteristics, malperfusion rates, and cardiac risk factors were similar between the two time periods. There was no difference in unadjusted operative mortality (19.01% pre-pandemic vs. 18.83% during, p = .9) nor major morbidity (52.42% pre-pandemic vs. 51.24% during, p = .5). Risk-adjusted multivariable models showed no difference in either operative mortality nor major morbidity between time periods. CONCLUSIONS For patients presenting to the hospital with ATAAD during the first surge of the pandemic, operative outcomes were similar to pre-pandemic despite a 30% reduction in volume. Out-of-hospital mortality from ATAAD during the pandemic remains unknown. Further understanding these findings will inform management of ATAAD during future pandemics.
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Affiliation(s)
- George J Arnaoutakis
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Tyler J Wallen
- Department of Surgery, Geisinger Health System, Wilkes Barre, Pennsylvania, USA
| | - Nimesh Desai
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tomas D Martin
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Vinod H Thourani
- Department of Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinay Badhwar
- Department of Cardiovascular & Thoracic Surgery, West Virginia University, Charlestown, West Virginia, USA
| | - Zachary K Wegerman
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rebecca Young
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Maria Grau-Sepulveda
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Brittany Zwischenberger
- Department of Cardiothoracic Surgery, Outcomes Research and Assessment Group, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Ibrahim Sultan
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA
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8
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Penso M, Frappampina A, Cosentino N, Tamborini G, Celeste F, Ianniruberto M, Ravagnani P, Troiano S, Marenzi G, Pepi M. Outcomes and mechanical complications of acute myocardial infarction during the second wave pandemic in a Milan HUB center for cardiac emergencies. Front Cardiovasc Med 2022; 9:950952. [PMID: 36262205 PMCID: PMC9573996 DOI: 10.3389/fcvm.2022.950952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/15/2022] [Indexed: 11/15/2022] Open
Abstract
Aims COVID-19 has dramatically impacted the healthcare system. Evidence from previous studies suggests a decline in in-hospital admissions for acute myocardial infarction (AMI) during the pandemic. However, the effect of the pandemic on mechanical complications (MC) in acute ST-segment elevation myocardial infarction (STEMI) has not been comprehensively investigated. Therefore, we evaluated the impact of the pandemic on MC and in-hospital outcomes in STEMI during the second wave, in which there was a huge SARS-CoV-2 diffusion in Italy. Methods and results Based on a single center cohort of AMI patients admitted with STEMI between February 1, 2019, and February 28, 2021, we compared the characteristics and outcomes of STEMI patients treated during the pandemic vs. those treated before the pandemic. In total, 479 STEMI patients were included, of which 64.5% were during the pandemic. Relative to before the pandemic, primary percutaneous coronary intervention (PCI) declined (87.7 vs. 94.7%, p = 0.014) during the pandemic. Compared to those admitted before the pandemic (10/2019 to 2/2020), STEMI patients admitted during the second wave (10/2020 to 2/2021) presented with a symptom onset-to-door time greater than 24 h (26.1 vs. 10.3%, p = 0.009) and a reduction of primary PCI (85.2 vs. 97.1%, p = 0.009). MC occurred more often in patients admitted during the second wave of the pandemic than in those admitted before the pandemic (7.0 vs. 0.0%, p = 0.032). In-hospital mortality increased during the second wave (10.6 vs. 2.9%, p = 0.058). Conclusion Although the experience gained during the first wave and a more advanced hub-and-spoke system for cardiovascular emergencies persists, late hospitalizations and a high incidence of mechanical complications in STEMI were observed even in the second wave.
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Affiliation(s)
- Marco Penso
- Centro Cardiologico Monzino IRCCS, Milan, Italy,Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy,*Correspondence: Marco Penso,
| | | | | | | | | | | | | | | | | | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Milan, Italy
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9
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Takasaki A, Kurita T, Yanagisawa M, Ino A, Hiramatsu D, Ikami A, Ito H, Kato T, Fukuoka S, Sugimoto T, Nakata T, Masuda J, Tanabe M, Kakimoto H, Dohi K. Demographic Trends and Changes in the Pre- and In-Hospital Medical Management of Acute Myocardial Infarction During the First 12 Months of the COVID-19 Pandemic in Mie Prefecture ― Report From the Mie ACS Registry ―. Circ Rep 2022; 4:412-421. [PMID: 36120481 PMCID: PMC9437476 DOI: 10.1253/circrep.cr-22-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Even though hospital admissions for acute myocardial infarction (AMI) decreased globally during the COVID-19 pandemic in early 2020, limited information is available on subsequent demographic trends in the number of cases and management of AMI through the first 12 months of the COVID-19 pandemic. Methods and Results: We assessed demographic trends, patient characteristics, and AMI outcomes (n=730) during the first 12 months of the COVID-19 pandemic and compared them with corresponding months during the control period (February 2016–January 2020; n=2,742) using data from the Mie ACS Registry. Although a 25.8% reduction in hospitalizations for AMI was observed in the 3 months following the declaration of a state of emergency (47.7 vs. 64.3/month; P=0.002), the total number of AMI patients was similar between the 12-month COVID-19 and control periods (60.8 vs. 57.2/month; P=0.58). The number of patients requiring direct ambulance transport was lower in the first half of the COVID-19 than control period (44.4% vs. 51.5; P=0.028). In-hospital mortality was higher in the second half of the COVID-19 than control period (8.9% vs. 5.8%; P=0.032). Conclusions: Through the first 12 months of the COVID-19 pandemic, the number of AMI cases was similar to that in previous years. The COVID-19 pandemic changed the behavior of AMI patients and both pre- and in-hospital medical management, which significantly affected the severity and prognosis of AMI.
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Affiliation(s)
- Akihiro Takasaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Ayaka Ino
- Department of Cardiology, Ise Red Cross Hospital
| | | | | | - Hiromasa Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Takashi Kato
- Department of Cardiology, Mie Prefecture General Medical Center
| | | | - Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Jun Masuda
- Department of Cardiology, Mie Prefecture General Medical Center
| | - Masaki Tanabe
- Department of Infection Control and Prevention, Mie University Hospital
| | | | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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10
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Late Presenters with ST-Elevation Myocardial Infarction: A Call to Action. J Clin Med 2022; 11:jcm11175169. [PMID: 36079099 PMCID: PMC9457385 DOI: 10.3390/jcm11175169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
The emphasis on timely coronary reperfusion in the setting of ST-segment elevation Myocardial Infarction (STEMI) comes from older studies suggesting a significant reduction in mortality among patients treated with fibrinolytic therapy during the first hours after onset of symptoms and a progressive increase in fatal events in those presenting later [...]
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11
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Hao K, Takahashi J, Sato K, Suda A, Sindo T, Godo S, Nishimiya K, Kikuchi Y, Shiroto T, Yasuda S. The influence of COVID-19 pandemic on management of acute myocardial infarction in Japan; Insight from the Miyagi AMI Registry Study. IJC HEART & VASCULATURE 2022; 43:101116. [PMID: 36127895 PMCID: PMC9477968 DOI: 10.1016/j.ijcha.2022.101116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022]
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12
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Albuquerque F, Lopes PM, Brízido C, Strong C, Andrade MJ, de Araújo Gonçalves P, Tralhão A. Severe hypoxemia in a patient with right ventricular myocardial infarction and SARS-CoV-2 infection. BMC Cardiovasc Disord 2022; 22:334. [PMID: 35902795 PMCID: PMC9330950 DOI: 10.1186/s12872-022-02765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 11/24/2022] Open
Abstract
Background Refractory hypoxemia after right ventricular myocardial infarction and concomitant SARS-CoV-2 infection represents an uncommon, yet particularly challenging clinical scenario. We report a challenging diagnostic case of refractory hypoxemia due to right-to-left shunt highlighting contemporary challenges and pitfalls in acute cardiovascular care associated with the current COVID-19 pandemic. Case presentation A 52-year-old patient admitted for inferior acute myocardial infarction developed rapidly worsening hypoxemia shortly after primary percutaneous coronary intervention. RT-PCR screening for SARS-CoV-2 was positive, even though the patient had no prior symptoms. A computed tomography pulmonary angiogram excluded pulmonary embolism and showed only mild interstitial pulmonary involvement of the virus. Transthoracic echocardiogram showed severe right ventricular dysfunction and significant right-to-left shunt at the atrial level after agitated saline injection. Progressive improvement of right ventricular function allowed weaning from supplementary oxygen support. Patient was latter discharged with marked symptomatic improvement. Conclusion Refractory hypoxemia after RV myocardial infarction should be carefully addressed, even in the setting of other more common and tempting diagnoses. After exclusion of usual etiologies, right-to-left shunting at the atrial level should always be suspected, as this may avoid unnecessary and sometimes harmful interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02765-9.
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Affiliation(s)
- Francisco Albuquerque
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal.
| | - Pedro M Lopes
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - Catarina Brízido
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - Christopher Strong
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - Maria João Andrade
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - Pedro de Araújo Gonçalves
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
| | - António Tralhão
- Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo dos Santos, 2790-134, Carnaxide, Lisbon, Portugal
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13
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Hoffman JRH, Higa KC, Lin Y, Reece TB, Cleveland JC, Aftab M, Rove JY. Noteworthy Cardiac Literature From 2021: Coronary Guideline Change Without New Data, Heart Transplant Donation After Cardiac Death, Covid Effects on Global Cardiac Surgery, and Attempt to Improve Dissection Remodeling. Semin Cardiothorac Vasc Anesth 2022; 26:154-161. [PMID: 35591803 DOI: 10.1177/10892532221101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac surgery continues to evolve. The last year has been notable for many reasons. The guidelines for coronary revascularization introduced significant discord. The pandemic continues to affect the care on a global scale. Advances in organ procurement and dissection care move forward with better understanding and better technology.
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Affiliation(s)
| | - Kelly C Higa
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Yihan Lin
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of, Surgery, 129263University of Colorado School of Medicine, Aurora, CO, USA
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14
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Choi H, Lee JH, Park HK, Lee E, Kim MS, Kim HJ, Park BE, Kim HN, Kim N, Jang SY, Bae MH, Yang DH, Park HS, Cho Y. Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction. J Korean Med Sci 2022; 37:e167. [PMID: 35638194 PMCID: PMC9151994 DOI: 10.3346/jkms.2022.37.e167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior. METHODS A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death. RESULTS There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic. CONCLUSION During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.
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Affiliation(s)
- Hyohun Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyuk Kyoon Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eunkyu Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myeong Seop Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyeon Jeong Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Bo Eun Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hong Nyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
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15
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Yamaji K, Kohsaka S, Inohara T, Numasawa Y, Ando H, Wada H, Ishii H, Amano T, Miyata H, Ikari Y. Percutaneous coronary intervention during the COVID-19 pandemic in Japan: Insights from the nationwide registration data. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100434. [PMID: 35330940 PMCID: PMC8939342 DOI: 10.1016/j.lanwpc.2022.100434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) has negatively affected access to healthcare systems and treatment timelines. This study was designed to explore the impact of the COVID-19 pandemic on patients who underwent percutaneous coronary intervention (PCI). Methods From January 2019 to December 2020, 489,001 patients from 1068 institutions were registered in the Japanese nationwide PCI (J-PCI) registry. We constructed generalized linear models to assess the difference in the daily number of patients and in-hospital outcomes between 2019 and 2020. Findings In total, 207 institutions (19·3%) had closed or restricted access during the first COVID-19 outbreak in May 2020; the number of closed or restricted institutions had plateaued at a median of 121 institutions (11·3%). The daily case volume of PCI significantly decreased in 2020 (by 6·7% compared with that in 2019; 95% confidence interval [CI], 6·2–7·2%; p < 0·001). Marked differences in the presentation of PCI patients were observed; more patients presented with ST-segment elevation myocardial infarction (18·3% vs. 17·5%; p < 0·001), acute heart failure (4·49% vs. 4·30%; p = 0·001), cardiogenic shock (3·79% vs. 3·45%; p < 0·001), and cardiopulmonary arrest (2·12% vs. 2·00%; p = 0·002) in 2020. The excess adjusted in-hospital mortality rate in patients treated in 2020 relative to those treated in 2019 was significant (adjusted odds ratio, 1·054; 95% CI, 1·004–1·107; p = 0·03). Interpretation While the number of patients who underwent PCI substantially decreased during the COVID-19 pandemic, more patients presented with high-risk characteristics and were associated with significantly higher adjusted in-hospital mortality. Funding The J-PCI registry is a registry led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics. The present study was supported by the Grant-in-Aid from the Ministry of Health and Labour (No. 20IA2002 and 21FA1015), the Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (KAKENHI; No. 21K08064), and the Japan Agency for Medical Research and Development (No. 17ek0210097h000).
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16
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The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063172. [PMID: 35328859 PMCID: PMC8953098 DOI: 10.3390/ijerph19063172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022]
Abstract
This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January–June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients’ delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events.
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17
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Pocar M, Totaro P, Rinaldi M, Pelenghi S. Coronavirus disease 2019 and cardiac surgery: lessons learnt from a round-trip to hell. J Cardiovasc Med (Hagerstown) 2022; 23:84-86. [PMID: 34958312 DOI: 10.2459/jcm.0000000000001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Marco Pocar
- Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza', University of Turin, Turin.,Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Pasquale Totaro
- Division of Cardiac Surgery, Policlinico San Matteo Scientific Institute, Pavia, Italy
| | - Mauro Rinaldi
- Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza', University of Turin, Turin
| | - Stefano Pelenghi
- Division of Cardiac Surgery, Policlinico San Matteo Scientific Institute, Pavia, Italy
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18
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Cardiovascular System during SARS-CoV-2 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031184. [PMID: 35162207 PMCID: PMC8835041 DOI: 10.3390/ijerph19031184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/20/2022]
Abstract
SARS-CoV-2 virus can not only damage the respiratory system but may also pose a threat to other organs, such as the heart or vessels. This review focuses on cardiovascular complications of COVID-19, including acute cardiac injury, arrhythmias, biomarkers, accompanying comorbidities and outcomes in patients diagnosed with SARS-CoV-2 infection. The research was conducted on the databases: PubMed, Springer, ScienceDirect, UpToDate, Oxford Academic, Wiley Online Library, ClinicalKey. Fifty-six publications from 1 November 2020 till 15 August 2021 were included in this study. The results show that cardiac injury is present in about 1 in 4 patients with COVID-19 disease, and it is an independent risk factor, which multiplies the death rate several times in comparison to infected patients without myocardial injury. New-onset cardiac injury occurs in nearly every 10th patient of the COVID-19-suffering population. Comorbidities (such as hypertension, cardiovascular disease and diabetes) severely deteriorate the outcome. Therefore, patients with SARS-CoV-2 infection should be carefully assessed in terms of cardiac medical history and possible cardiological complications.
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19
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Bowsher G, Bernard R, Sullivan R. Building Resilient Health Systems Intelligence: Adapting Indicators of Compromise for the Cyber-Bionexus. Health Secur 2021; 19:625-632. [PMID: 34870478 DOI: 10.1089/hs.2021.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The health sector is an underutilized source of actionable health intelligence for responding to threats across the "cyber-bionexus," defined as the convergence of threats from the biological and cybersecurity domains to produce harms with widespread societal consequences. The escalation of concerns about such threats-related to misinformation and disinformation; chemical, biological, radiological, and nuclear events; cyberattacks; natural disease outbreaks; and disasters of various kinds-places health system concerns squarely at the forefront of national critical systems and broader security imperatives. Events such as the COVID-19 pandemic have highlighted the dearth of systems available for generating real-time intelligence in relation to critical functions of health sector operations amidst an unfolding crisis. Drawing on principles from the field of cyberthreat intelligence, and building on existing scholarship in health security intelligence, we propose a model for applying health system indicators of compromise for cyberbio events. We further discuss the relevance of this approach within the broader landscape of the cyber-bionexus to signal new pathways for research, practice, and policy engagement.
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Affiliation(s)
- Gemma Bowsher
- Gemma Bowsher, MBBS, is a Research Associate, Research for Health in Conflict in the Middle East and North Africa (R4HC-MENA); Rose Bernard, MA, is a Research Associate; and Richard Sullivan, PhD, is Co-Director, R4HC-MENA; all in Conflict and Health Research Group, Department of War Studies, King's College London, London, UK
| | - Rose Bernard
- Gemma Bowsher, MBBS, is a Research Associate, Research for Health in Conflict in the Middle East and North Africa (R4HC-MENA); Rose Bernard, MA, is a Research Associate; and Richard Sullivan, PhD, is Co-Director, R4HC-MENA; all in Conflict and Health Research Group, Department of War Studies, King's College London, London, UK
| | - Richard Sullivan
- Gemma Bowsher, MBBS, is a Research Associate, Research for Health in Conflict in the Middle East and North Africa (R4HC-MENA); Rose Bernard, MA, is a Research Associate; and Richard Sullivan, PhD, is Co-Director, R4HC-MENA; all in Conflict and Health Research Group, Department of War Studies, King's College London, London, UK
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20
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Watanabe Y, Miyachi H, Mozawa K, Yamada K, Oka E, Shiomura R, Sugizaki Y, Matsuda J, Nakata J, Tara S, Tokita Y, Iwasaki YK, Yamamoto T, Takano H, Shimizu W. Impact of the COVID-19 Pandemic on ST-elevation Myocardial Infarction from a Single-center Experience in Tokyo. Intern Med 2021; 60:3693-3700. [PMID: 34565777 PMCID: PMC8710378 DOI: 10.2169/internalmedicine.8220-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare systems. Some studies have reported the negative impact of COVID-19 on ST-elevation myocardial infarction (STEMI) patients; however, the impact in Japan remains unclear. This study investigated the impact of the COVID-19 pandemic on STEMI patients admitted to an academic tertiary-care center in Tokyo, Japan. Methods In this retrospective, observational, cohort study, we included 398 consecutive patients who were admitted to our institute from January 1, 2018, to March 10, 2021, and compared the incidence of hospitalization, clinical characteristics, time course, management, and outcomes before and after March 11, 2020, the date when the World Health Organization declared COVID-19 a pandemic. Results There was a 10.7% reduction in hospitalization of STEMI patients during the COVID-19 pandemic compared with that in the previous year (117 vs. 131 cases). During the COVID-19 pandemic, the incidence of late presentation was significantly higher (26.5% vs. 12.1%, p<0.001), and the onset-to-door [241 (IQR: 70-926) vs. 128 (IQR: 66-493) minutes, p=0.028] and door-to-balloon [72 (IQR: 61-128) vs. 60 (IQR: 43-90) min, p<0.001] times were significantly longer than in the previous year. Furthermore, the in-hospital mortality was higher, but the difference was not significant (9.4% vs. 5.0%, p=0.098). Conclusion The COVID-19 pandemic significantly impacted STEMI patients in Tokyo and resulted in a slight decrease in hospitalization, a significant increase in late presentation and treatment delays, and a slight but nonsignificant increase in mortality. In the COVID-19 era, the acute management system for STEMI in Japan must be reviewed.
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Affiliation(s)
- Yukihiro Watanabe
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Hideki Miyachi
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Kosuke Mozawa
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Kenta Yamada
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Eiichiro Oka
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Yoichiro Sugizaki
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Junya Matsuda
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Yukichi Tokita
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Japan
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21
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Naruse H, Ito H, Izawa H, Sarai M, Ishii J, Sakaguchi E, Murakami R, Ando T, Fujigaki H, Saito K. Immunogenicity of BNT162b2 mRNA COVID-19 Vaccine in Patients with Cardiovascular Disease. J Clin Med 2021; 10:jcm10235498. [PMID: 34884205 PMCID: PMC8658500 DOI: 10.3390/jcm10235498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 01/14/2023] Open
Abstract
Concern has been raised about the effectiveness of the coronavirus disease 2019 (COVID-19) vaccine in the population of patients with various comorbidities such as heart disease. We investigated the humoral response to the BNT162b2 mRNA COVID-19 vaccine in patients with cardiovascular disease (CVD). We measured IgG against severe acute respiratory syndrome coronavirus 2 spike receptor-binding domain (RBD-IgG) in 85 CVD patients and 179 healthcare workers (HCWs). Blood samples were collected from patients and HCWs three times: (1) before the first dose of vaccination, (2) two weeks after the first dose of vaccination, and (3) two weeks after the second dose of vaccination. Patients with CVD showed a significantly inferior serological response to the BNT162b2 mRNA COVID-19 vaccine at 14 days after the prime dose compared to HCWs (21% vs. 95%, p < 0.001). Median RBD-IgG titers of patients with CVD at 14 days after the second dose were significantly lower than those of HCWs (137.2 U/mL (80.6-200.4 U/mL) vs. 176.2 U/mL (123.9-260.0 U/mL), p < 0.001). In multivariable analyses, CVD is significantly associated with seropositivity after first vaccination and RBD-IgG titers after second vaccination. CVD patients may have a poor humoral response to the BNT162b2 mRNA COVID-19 vaccine, need to be closely monitored, and require earlier revaccination to ensure stronger immunity and protection against infection.
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Affiliation(s)
- Hiroyuki Naruse
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan;
- Correspondence: ; Tel.: +81-562-93-2312; Fax: +81-562-93-2315
| | - Hiroyasu Ito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (M.S.)
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (M.S.)
| | - Junnichi Ishii
- Bantane Hospital, Fujita Health University School of Medicine, Nagoya 454-8509, Japan;
| | - Eirin Sakaguchi
- Department of Clinical Pathophysiology, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan;
| | - Reiko Murakami
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Tatsuya Ando
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, Japan; (H.I.); (R.M.); (T.A.)
| | - Hidetsugu Fujigaki
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan; (H.F.); (K.S.)
| | - Kuniaki Saito
- Department of Advanced Diagnostic System Development, Fujita Health University Graduate School of Health Sciences, Toyoake 470-1192, Japan; (H.F.); (K.S.)
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22
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Barbati G, Erente G, Magagna P, Spigolon L, Caprioglio F. Multi-modality imaging of post-myocardial infarction ventricular septal defect associated to basal inferoseptal pseudoaneurysm. J Echocardiogr 2021; 21:79-80. [PMID: 34528167 PMCID: PMC8442649 DOI: 10.1007/s12574-021-00551-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/24/2021] [Accepted: 09/03/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Giovanni Barbati
- Department of Cardiology, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy.
| | - Giovanna Erente
- Department of Cardiology, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Paolo Magagna
- Department of Cardiac Surgery, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Luca Spigolon
- Department of Radiology, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Francesco Caprioglio
- Department of Cardiology, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy
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23
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Khorolsky C, Pettijohn D, Yager N. Post-Infarction Ventricular Septal Rupture Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support as a Bridge to Definitive Therapy During the COVID-19 Pandemic. Cureus 2021; 13:e16421. [PMID: 34422462 PMCID: PMC8369983 DOI: 10.7759/cureus.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/05/2022] Open
Abstract
Ventricular septal rupture (VSR) is a devastating complication of acute myocardial infarction (MI) and is often associated with cardiogenic shock. Although considered to be very rare in the reperfusion era, recent reports have demonstrated an increased frequency of post-MI VSR cases during the COVID-19 pandemic. Despite advances in surgical repair and management strategies over the past decades, mortality rate has remained high, especially in hemodynamically unstable patients. In VSR patients with cardiogenic shock, the use of mechanical circulatory support (MCS) could be used as a bridge to surgical intervention. We report a patient with VSR complicated by cardiogenic shock secondary to late presenting MI, managed successfully with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to surgical intervention.
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Affiliation(s)
| | | | - Neil Yager
- Cardiology, Albany Medical College, Albany, USA
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24
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Nguyen TC, Thourani VH, Nissen AP, Habib RH, Dearani JA, Ropski A, Crestanello JA, Shahian DM, Jacobs JP, Badhwar V. The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients. Ann Thorac Surg 2021; 113:738-746. [PMID: 34343473 PMCID: PMC8325556 DOI: 10.1016/j.athoracsur.2021.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
Background COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels. Methods The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from January 1, 2018, to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020, to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality. Results The study analyzed 717 103 adult cardiac surgery patients and more than 20 million COVID-19 patients. Nationally, there was a 52.7% reduction in adult cardiac surgery volume and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19–associated deficit of cardiac surgery patients. Conclusions This large analysis of COVID-19–related impact on adult cardiac surgery volume, trends, and outcomes found that during the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.
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Affiliation(s)
- Tom C Nguyen
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, California.
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Alexander P Nissen
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allan Ropski
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | | | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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25
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Covid and Cardiovascular Diseases: Direct and Indirect Damages and Future Perspective. High Blood Press Cardiovasc Prev 2021; 28:439-445. [PMID: 34173942 PMCID: PMC8233573 DOI: 10.1007/s40292-021-00464-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 infection determines a disease that predominantly affects lungs. However the cytokines storms, determined by the huge immune response to the infection, could affect also other organs and apparatus such as heart and vessels. Beyond the acute inflammation itself also hypercoagulative status has been linked to SARSCoV-2 infection and this surely relates to the increase seen in prevalence of pulmonary embolism and myocardial infarction. A number of cardiac abnormalities and pathologies have been observed, with special attention to cardiac arrhythmias and myocardial involvement. Furthermore, indirect damages determined by the reduction in acute and chronic cardiovascular care, results in a strong mortality and morbidity outcomes in cardiological patients. In this review we will summarise current knowledge on both direct and indirect cardiovascular damages determined by the SARS-CoV-2 pandemia.
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26
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Recent insights into pathophysiology and management of mechanical complications of myocardial infarction. Curr Opin Cardiol 2021; 36:623-629. [PMID: 34397468 DOI: 10.1097/hco.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Mechanical complications of myocardial infarction are a group of postischemic events and include papillary muscle rupture resulting in ischemic mitral regurgitation, ventricular septal defect, left ventricle free wall rupture, pseudoaneurysm, and true aneurysm. Advances made in management strategies, such as the institution of 'Code STEMI' and percutaneous interventions, have lowered the incidence of these complications. However, their presentation is still associated with increased morbidity and mortality. Early diagnosis and appropriate management is crucial for facilitating better clinical outcomes. RECENT FINDINGS Although the exact timing of a curative intervention is not known, emerging percutaneous and transcatheter approaches and improving mechanical circulatory support (MCS) devices have greatly enhanced our ability to manage and treat some of the complications postinfarct. SUMMARY Although the incidence of mechanical complications of myocardial infarction has decreased over the past few decades, these complications are still associated with high rates of morbidity and mortality. The combination of early and accurate diagnosis and subsequent appropriate management are imperative for optimizing clinical outcomes. Although more randomized clinical trials are needed, mechanical circulatory support devices and emerging therapeutic strategies can be offered to carefully selected patients.
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27
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Nissen AP, Nguyen TC. Commentary: Coronary artery bypass grafting during COVID: Safe for some, but where are the rest? ACTA ACUST UNITED AC 2021; 6:146-147. [PMID: 33937880 PMCID: PMC8080169 DOI: 10.1016/j.xjon.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Alexander P Nissen
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Tex
| | - Tom C Nguyen
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco, San Francisco, Calif
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28
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Ishii H, Amano T, Kohsaka S, Morino Y, Yokoi H, Ikari Y. National survey of percutaneous coronary intervention during the COVID-19 pandemic in Japan: second report of the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2021; 37:264-268. [PMID: 33864606 PMCID: PMC8052934 DOI: 10.1007/s12928-021-00776-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 02/06/2023]
Abstract
Healthcare systems worldwide have been overburdened by the coronavirus disease 2019 (COVID-19) outbreak. Accordingly, hospitals have had to implement strategies to profoundly reorganize activities, which have affected procedures such as primary percutaneous coronary interventions (PCIs). This study aimed to describe changes in PCI practices during the health emergency at the national level. The Japanese Association of Cardiovascular Intervention and Therapeutics performed provided serial surveys of institutions throughout Japan during the pandemic. The data obtained on December, 2020 and February 2021 (during the 2nd wave of pandemic) were compared with the data obtained on August 2020 (1st wave). Primary PCI for STEMI was performed as usual in 99.1%, 98.7%, and 97.5% of institutions in mid-August, mid-December, 2020 and mid-February, 2021, respectively. The COVID-19 screening tests rates in patients were significantly higher during the third wave than during the second wave (54.0% in mid-August, 2020 and 64.6% in mid-February, 2021, P = 0.002). In addition, hospitals reported that personal protective equipment was more available over time (66.4% in mid-August, 2020 and 83.8% in mid-February, 2021, P < 0.001). In conclusion, most institutions surveyed in Japan continued to perform primary PCI as usual for STEMI patients during the second and third waves of the COVID-19 pandemic. In addition, the COVID-19 screening tests were more frequently performed over time.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, 454-8509, Japan.
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University, Tokyo, Japan
| | - Yoshihiro Morino
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University, Isehara, Japan
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29
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Chew NW, Ow ZGW, Teo VXY, Heng RRY, Ng CH, Lee CH, Low AF, Chan MYY, Yeo TC, Tan HC, Loh PH. The Global Impact of the COVID-19 Pandemic on STEMI care: A Systematic Review and Meta-Analysis. Can J Cardiol 2021; 37:1450-1459. [PMID: 33848599 PMCID: PMC8056787 DOI: 10.1016/j.cjca.2021.04.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic has affected patients with ST-segment elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI) worldwide. This review examines the global impact of COVID-19 pandemic on incidence of STEMI admissions, and relationship between the pandemic and door-to-balloon time (D2B), all-cause mortality and other secondary STEMI outcomes. METHODS We performed a systematic review and meta-analysis to primarily compare D2B time and in-hospital mortality of STEMI patients who underwent primary PCI during and before the pandemic. Subgroup analyses were performed to investigate the influence of geographical region and income status of a country on STEMI care. An online database search included studies comparing the aforementioned outcomes between STEMI patients during and before the pandemic. RESULTS In total, 32 articles were analyzed. Overall, 19,140 and 68,662 STEMI patients underwent primary PCI during and before the pandemic respectively. Significant delay in D2B was observed during the pandemic (WMD=8.10mins; CI:3.90-12.30mins; p=0.0002, I2=90%). In-hospital mortality was higher during the pandemic (OR=1.27; CI:1.09-1.49; p=0.002, I2=36%), however this varied with factors such as geographical location and income status of a country. Subgroup analysis found that low-middle income countries observed a higher rate of mortality during the pandemic (OR=1.52; CI:1.13-2.05; p=0.006), with a similar but insignificant trend seen among the high income countries (OR=1.17; CI:0.95-1.44; p=0.13). CONCLUSION The COVID-19 pandemic is associated with worse STEMI performance metrics and clinical outcome, particularly in the Eastern low-middle income status countries. Better strategies are needed to address these global trends in STEMI care during the pandemic.
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Affiliation(s)
- Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
| | | | - Vanessa Xin Yi Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ryan Rui Yang Heng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adrian F Low
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay-Huan Loh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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