Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Diseases, Beijing, China.
Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China.
Catheter Cardiovasc Interv. 2021 Mar;97(4):E475-E483. doi: 10.1002/ccd.29145. Epub 2020 Jul 29.
During coronavirus disease 2019 (COVID-19) epidemic, reducing the number of invasive procedure and choosing conservative medication strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unavoidable. Whether this relatively conservative strategy will impact in-hospital outcome for NSTEMI patients remains unclear.
The current study included all consecutive NSTEMI patients who visited the emergency department in Fuwai Hospital from February 1 to March 31, 2020 and all the NSTEMI patients in the same period of 2019 as a historical control. Very-high-risk patients were defined as clinical presentation of heart failure, cardiac shock, cardiac arrest, recurrent chest pain, and life-threatening arrhythmias. The primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of all-cause death, recurrent myocardial infarction, or heart failure. A total of 115 NSTEMI patients were enrolled since the outbreak of COVID-19, and a total of 145 patients were included in the control group. There was a tendency toward higher MACE risk in 2020 compared with 2019 (18.3% vs. 11.7%, p = .14). Among very-high-risk patients, early percutaneous coronary intervention (PCI) strategy in 2019 was associated with reduced MACE risk compared with delayed PCI in 2020 (60.6% [20/33] in 2020 vs. 27.9% [12/43] in 2019, p = .01).
COVID-19 pandemic results in a significant reduction in immediate/early PCI and a trend toward higher adverse event rate during hospitalization, particular in very-high-risk patients.
在 2019 冠状病毒病（COVID-19）流行期间，减少非 ST 段抬高型心肌梗死（NSTEMI）患者的有创操作数量并选择保守的药物治疗策略是不可避免的。这种相对保守的策略是否会影响 NSTEMI 患者的住院结局尚不清楚。
本研究纳入了 2020 年 2 月 1 日至 3 月 31 日期间因 NSTEMI 就诊于阜外医院急诊科的所有连续患者，以及 2019 年同期的所有 NSTEMI 患者作为历史对照。极高危患者定义为心力衰竭、心源性休克、心脏骤停、反复胸痛和危及生命的心律失常的临床表现。主要终点是住院期间的主要不良心脏事件（MACE），定义为全因死亡、再发心肌梗死或心力衰竭的复合终点。自 COVID-19 爆发以来，共纳入 115 例 NSTEMI 患者，对照组共纳入 145 例患者。2020 年 MACE 风险较 2019 年有升高趋势（18.3%比 11.7%，p=0.14）。在极高危患者中，2019 年早期经皮冠状动脉介入治疗（PCI）策略与 2020 年延迟 PCI 相比，MACE 风险降低（2020 年为 60.6%[20/33]，2019 年为 27.9%[12/43]，p=0.01）。
COVID-19 大流行导致即刻/早期 PCI 显著减少，住院期间不良事件发生率呈上升趋势，尤其是在极高危患者中。
