Impact of COVID‐19 on percutaneous coronary intervention utilization and mortality in New York

Abstract

AbstractBackgroundCOVID‐19 has disrupted the care of all patients, and little is known about its impact on the utilization and short‐term mortality of percutaneous coronary intervention (PCI) patients, particularly nonemergency patients.MethodsNew York State's PCI registry was used to study the utilization of PCI and the presence of COVID‐19 in four patient subgroups ranging in severity from ST‐elevation myocardial infarction (STEMI) to elective patients before (December 01, 2018–February 29, 2020) and during the COVID‐19 era (March 01, 2020–May 31, 2021), as well as to examine the impact of different COVID severity levels on the mortality of different types of PCI patients.ResultsDecreases in the mean quarterly PCI volume from the prepandemic period to the first quarter of the pandemic ranged from 20% for STEMI patients to 61% for elective patients, with the other two subgroups having decreases in between these values. PCI quarterly volume rebounds from the prepandemic period to the second quarter of 2021 were in excess of 90% for all patient subgroups, and 99.7% for elective patients. Existing COVID‐19 was rare among PCI patients, ranging from 1.74% for STEMI patients to 3.66% for elective patients. PCI patients with COVID‐19 and acute respiratory distress syndrome (ARDS) who were not intubated, and PCI patients with COVID‐19 and ARDS who were either intubated or were not intubated because of Do Not Resuscitate//Do Not Intubate status had higher risk‐adjusted mortality ([adjusted ORs = 10.81 [4.39, 26.63] and 24.53 [12.06, 49.88], respectively]) than patients who never had COVID‐19.ConclusionsThere were large decreases in the utilization of PCI during COVID‐19, with the percentage of decrease being highly sensitive to patient acuity. By the second quarter of 2021, prepandemic volumes were nearly restored for all patient subgroups. Very few PCI patients had current COVID‐19 throughout the pandemic period, but the number of PCI patients with a COVID‐19 history increased steadily during the pandemic. PCI patients with COVID‐19 accompanied by ARDS were at much higher risk of short‐term mortality than patients who never had COVID‐19. COVID‐19 without ARDS and history of COVID‐19 were not associated with higher mortality for PCI patients as of the second quarter of 2021.