There was no change in the volume of PCI for acute coronary syndromes (ACS) in Melbourne during the early months of the COVID-19 pandemic compared to pre-pandemic months, a review has found.
A study of 984 consecutive ACS patients treated in the Monash Health hospital network compared PCI rates and outcomes in the pre-pandemic period (11 March 2019-10 March 2020) to the pandemic period (11 March 2020–10 May 2020).
It found lockdown measures in the context of initially low rates of COVID-19 infection did not impact the volume of PCI for ACS (2.3 v 2.4 PCI per day, pre- and during pandemic respectively).
Similarly, the proportion of PCI performed for STEMI, NSTEMI and unstable angina was unchanged between time periods.
“Procedural success was high in both the pandemic and pre-pandemic ACS groups (94.6% vs 95.4%, p=0.71) and there were no significant differences in in-hospital outcomes such as length of stay (LOS), bleeding and stroke,” the study said.
In a sub-group of STEMI patients, there was a significant increase in door-to-balloon time (DTBT) during the pandemic period but without any change to in-hospital outcomes.
The study, published in Heart, Lung and Circulation, said the DTBT delay was likely due to the introduction of stringent PPE protocols, screening questions and mandatory COVID-19 testing in the ED prior to proceeding to the cath lab.
“Interrupted time series analysis also demonstrated that the prolongation in DTBT during the pandemic period was greatest at the beginning of this period and improved throughout the course of the pandemic.”
“This finding likely reflects the healthcare service adapting over time with streamlining of processes.”
The study noted the findings contrasted with those from several other countries which saw significant drops in ACS presentations and interventional procedures during the early pandemic.
“The unchanged PCI volumes at our institution may be due to the much smaller scale of the initial COVID-19 outbreak in Australia.”
“While our findings are reassuring that ACS and STEMI patients have not been negatively impacted in the short term by the pandemic and consequent longer DTBT, studies examining the longer term effects of the pandemic are needed.”