COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

Oettinger, Vera; Stachon, Peter; Hilgendorf, Ingo; Heidenreich, Adrian; Zehender, Manfred; Westermann, Dirk; Kaier, Klaus; Mühlen, Constantin von zur

doi:10.1007/s00392-022-02102-2

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Values of stroke in TA-TAVR could not be calculated due to a stroke rate of 0.00% in TA-TAVR. patients (14), lower numbers could have been expected, as this also was observed in acute ST-elevation myocardial infarction (15). Furthermore, in contrast to a previously stated rise of TA-TAVR procedures (5), we now observe noticeably fewer cases compared to the steadily increasing TF-TAVR numbers.…”

Section: Discussionsupporting

confidence: 43%

“…Nevertheless, compared to a previous analysis of TAVR in aortic regurgitation in Germany from 2008 to 2015 ( 5 ), we see a further growth of TAVR procedures. The increased TAVR numbers in 2020 are particularly surprising: Due to the COVID-19 pandemic with lockdown restrictions in 2020 in Germany, including postponing elective procedures to provide hospital resources for COVID-19 patients ( 14 ), lower numbers could have been expected, as this also was observed in acute ST-elevation myocardial infarction ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany

Oettinger

Hilgendorf

Wolf

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIn pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data.MethodsBy use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation between 2018 and 2020 in Germany.Results4,861 procedures—4,025 SAVR and 836 TAVR—for aortic regurgitation were identified. Patients treated with TAVR were older, showed a higher logistic EuroSCORE, and had more pre-existing diseases. While results indicate a slightly higher unadjusted in-hospital mortality for transapical TAVR (6.00%) vs. SAVR (5.71%), transfemoral TAVR showed better outcomes, with self-expanding compared to balloon-expandable transfemoral TAVR having significantly lower in-hospital mortality (2.41% vs. 5.17%; p = 0.039). After risk adjustment, balloon-expandable as well as self-expanding transfemoral TAVR were associated with a significantly lower mortality vs. SAVR (balloon-expandable: risk adjusted OR = 0.50 [95% CI 0.27; 0.94], p = 0.031; self-expanding: OR = 0.20 [0.10; 0.41], p < 0.001). Furthermore, the observed in-hospital outcomes of stroke, major bleeding, delirium, and mechanical ventilation >48 h were significantly in favor of TAVR. In addition, TAVR showed a significantly shorter length of hospital stay compared to SAVR (transapical: risk adjusted Coefficient = −4.75d [−7.05d; −2.46d], p < 0.001; balloon-expandable: Coefficient = −6.88d [−9.06d; −4.69d], p < 0.001; self-expanding: Coefficient = −7.22 [−8.95; −5.49], p < 0.001).ConclusionsTAVR is a viable alternative to SAVR in the treatment of pure aortic regurgitation for selected patients, showing overall low in-hospital mortality and complication rates, especially with regard to self-expanding transfemoral TAVR.

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Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany

Oettinger

Hilgendorf

Wolf

et al. 2023

Front. Cardiovasc. Med.

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“…A study by Furnica et al [ 37 ] found that the incidence of STEMI decreased by 48.8% during the COVID-19 pandemic compared to the same time in the previous year[ 37 ]. Another study by Oettinger et al [ 38 ] reported a similar increase in STEMI incidence of 22.9% during the COVID-19 pandemic[ 38 ]. These findings suggest that there may be an association between the declining incidence of STEMI and the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 85%

Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis

Khedr¹,

Hennawi²,

Khan³

et al. 2023

World J Cardiol

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BACKGROUND ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints. AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes. METHODS PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale. RESULTS Fourteen studies including 50136 STEMI patients ( n = 15142 in the pandemic arm; n = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR: 1.80 (1.18 to 2.75); I 2 = 78%; P = 0.00; GRADE: Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR: 5.16 (2.18 to 12.22); I 2 = 81%; P = 0.00; GRADE: Very low] and an increased risk of all-cause mortality in STEMI patients [OR: 1.16 (1.03 to 1.30); I 2 = 0%; P = 0.01; GRADE: Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia ( P = 0.001) and hypertension ( P < 0.001) with all-cause mortality. CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.

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Catheter based left atrial appendage closure in-hospital outcomes in Germany from 2016 to 2020

Maier,

Kaier,

Heidt

et al. 2023

Clin Res Cardiol

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Background New and refined catheter based left atrial appendage (LAA) closure devices have been introduced in the past decade. The procedure can be performed using either an endocardial occlusion device or an epicardial loop stitch. We aimed to analyzed recent procedural safety. Methods Catheter based LAA closures were identified in a complete nationwide German dataset via ICD and OPS codes from 2016 to 2020. Results From 2016 to 2020, 28,039 endocardial and 213 epicardial occlusions were performed. Numbers of endocardial procedures increased from 5259 in 2016 to 5917 in 2020 (p = 0.020) in 387 centers with shifting of patients’ characteristics towards older age (β = 0.29, p < 0.001), more heart failure (β = 1.01, p < 0.001) and renal disease (β = 0.67, p = 0.001) and without a significant trend for in-hospital safety except more bleeding (β = 0.12, p = 0.05). In-hospital major adverse cardiac and cerebrovascular events (MACCE) or pericardial puncture were independent on center procedure numbers. The loop stitch procedure was performed in 15 centers. Patients were younger (76.17 ± 8.16 vs. 73.16 ± 8.99, p < 0.001) and had a lower comorbidity index (2.29 ± 1.93 vs. 1.92 ± 1.64, p = 0.005). Adjusted risk difference for pericardial effusion (8.04%; 95% CI 3.01–13.08%; p = 0.002) and pericardial puncture (6.60%; 95% CI 3.85–9.35%; p < 0.001) was higher for the loop stitch procedure, while risk of bleeding (− 1.85%; 95% CI − 3.01 to − 0.69%; p = 0.002), intracerebral bleeding (− 0.37%; 95% CI − 0.59 to − 0.15%; p = 0.001) and shock (− 1.41%; 95% CI − 2.44 to − 0.39%; p = 0.007) was lower. No significant difference was observed for in-hospital MACCE. Conclusions Endocardial occlusion was the major catheter based LAA closure procedure in Germany without improvements in in-hospital safety from 2016 to 2020. In-hospital MACCE was independent on endocardial LAAC center volumes. Conclusions on the comparison between the two procedure types must be made cautious as the LAA loop stitch occlusion was utilized limited in a minor number of centers. Graphical abstract Catheter based left atrial appendage closure in-hospital outcomes in Germany from 2016 to 2020

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COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

Cited by 6 publications

References 26 publications

Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany

Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany

Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis

Catheter based left atrial appendage closure in-hospital outcomes in Germany from 2016 to 2020

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