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Impact of COVID-19 pandemic on the management of nonculprit lesions in patients presenting with ST-elevation myocardial infarction: Outcomes from the pan-London heart attack centers

Research output: Contribution to journalArticlepeer-review

Ozan Demir, Callum D Little, Richard Jabbour, Haseeb Rahman, Max Sayers, Asrar Ahmed, Michelle J Connolly, Ritesh Kanyal, Philip MacCarthy, Simon J Wilson, Miles C. Dalby, Ajay K. Jain, Iqbal S. Malik, Roby D. Rakhit, Divaka Perera

Original languageEnglish
JournalCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
Early online date30 Dec 2021
DOIs
Accepted/In press14 Dec 2021
E-pub ahead of print30 Dec 2021

Bibliographical note

Funding Information: This study was supported by the British Heart Foundation (PG/19/9/34228) and the National Institute for Health Research via the Biomedical Research Centre award to Guy's and St Thomas' Hospital and King's College London. Publisher Copyright: © 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

King's Authors

Abstract

Background: The impact of COVID-19 on the diagnosis and management of nonculprit lesions remains unclear. Objectives: This study sought to evaluate the management and outcomes of patients with nonculprit lesions during the COVID-19 pandemic. Methods: We conducted a retrospective observational analysis of consecutive primary percutaneous coronary intervention (PPCI) pathway activations across the heart attack center network in London, UK. Data from the study period in 2020 were compared with prepandemic data in 2019. The primary outcome was the rate of nonculprit lesion percutaneous coronary intervention (PCI) and secondary outcomes included major adverse cardiovascular events. Results: A total of 788 patients undergoing PPCI were identified, 209 (60%) in 2020 cohort and 263 (60%) in 2019 cohort had nonculprit lesions (p =.89). There was less functional assessment of the significance of nonculprit lesions in the 2020 cohort compared to 2019 cohort; in 8% 2020 cohort versus 15% 2019 cohort (p =.01). There was no difference in rates of PCI for nonculprit disease in the 2019 and 2020 cohorts (31% vs 30%, p =.11). Patients in 2020 cohort underwent nonculprit lesion PCI sooner than the 2019 cohort (p <.001). At 6 months there was higher rates of unplanned revascularization (4% vs. 2%, p =.05) and repeat myocardial infarction (4% vs. 1%, p =.02) in the 2019 cohort compared to 2020 cohort. Conclusion: Changes to clinical practice during the COVID-19 pandemic were associated with reduced rates of unplanned revascularization and myocardial infarction at 6-months follow-up, and despite the pandemic, there was no difference in mortality, suggesting that it is not only safe but maybe more efficacious.

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