Revascularisation strategies in patients with significant left main coronary disease during the COVID‐19 pandemic

Abstract

Background There are limited data on the impact of the COVID‐19 pandemic on left main (LM) coronary revascularisation activity, choice of revascularisation strategy, and post‐procedural outcomes. Methods All patients with LM disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020 were included ( n = 22,235), stratified by time‐period (pre‐COVID: 01/01/2017–29/2/2020; COVID: 1/3/2020–19/8/2020) and revascularisation strategy (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of 1) receipt of CABG (vs. PCI) and 2) in‐hospital and 30‐day postprocedural mortality, in the COVID‐19 period (vs. pre‐COVID). Results There was a decline of 1,354 LM revascularisation procedures between March 1, 2020 and July 31, 2020 compared with previous years' (2017–2019) averages (−48.8%). An increased utilization of PCI over CABG was observed in the COVID period (receipt of CABG vs. PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in‐hospital or 30‐day mortality was observed between pre‐COVID and COVID periods for both PCI (odds ratio (OR): 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups. Conclusion LM revascularisation activity has significantly declined during the COVID period, with a shift towards PCI as the preferred strategy. Postprocedural mortality within each revascularisation group was similar in the pre‐COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularisation activity to pre‐COVID levels.

Sex differences in high‐risk but indicated coronary interventions (CHiP): National report from British Cardiovascular Intervention Society Registry

“…We analyzed all patients who underwent PCI for stable angina in England and Wales between January 1, 2006, to December 31, 2017, in the BCIS database. Based on our previously published work, CHiP was defined as any procedure with at least one clinical high‐risk feature, such as (age ≥ 80, previous history of CABG or chronic renal failure, or severely impaired left ventricular function) and/or one procedural (anatomical) high‐risk factor such as (left main PCI, severe vessel calcification, chronic total occlusion PCI, or the need of LV support) 5,17,18 . All CHiP procedures were then stratified by sex into male or female groups.…”

Cardiovascular Health Care Implications of the COVID-19 pandemic

“…There was also evidence of change in choice of procedural strategy. Amongst patients with left main coronary artery stenosis in the UK, there was observation of both a reduction in revascularisation procedures and greater use of PCI over coronary artery bypass grafting 36 .…”

Impact of COVID-19 on Management Strategies for Coronary and Structural Heart Disease Interventions

“…As a consequence, a study from England showed a 48.8% reduction in left main revascularization during the pandemic compared with previous years, with a shift towards PCI as the preferred strategy to minimize patients’ exposure to the hospital environment and preserve ICU beds for COVID-19 patients. Post-procedural mortality remained the same in the both pre-COVID-19 and COVID-19 periods, suggesting that quality of outcomes was maintained during the pandemic [ 24 ].…”

“…Patients awaiting structural heart disease (SHD) interventions constitute a particularly challenging group, as many have conditions that might be life threatening if the intervention is inappropriately delayed [ 25 •, 26 – 29 ]. Studies have shown a decline in surgical and transcatheter aortic valve procedures during the pandemic with potential increase in mortality [ 24 , 25 •, 26 – 29 ] (Fig. 1 ).…”