Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Catheter Cardiovasc Interv. 2021 Dec 1;98(7):1252-1261. doi: 10.1002/ccd.29663. Epub 2021 Mar 25.
There are limited data on the impact of the COVID-19 pandemic on left main (LM) coronary revascularisation activity, choice of revascularisation strategy, and post-procedural outcomes.
All patients with LM disease (≥50% stenosis) undergoing coronary revascularisation in England between January 1, 2017 and August 19, 2020 were included (n = 22,235), stratified by time-period (pre-COVID: 01/01/2017-29/2/2020; COVID: 1/3/2020-19/8/2020) and revascularisation strategy (percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of 1) receipt of CABG (vs. PCI) and 2) in-hospital and 30-day postprocedural mortality, in the COVID-19 period (vs. pre-COVID).
There was a decline of 1,354 LM revascularisation procedures between March 1, 2020 and July 31, 2020 compared with previous years' (2017-2019) averages (-48.8%). An increased utilization of PCI over CABG was observed in the COVID period (receipt of CABG vs. PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in-hospital or 30-day mortality was observed between pre-COVID and COVID periods for both PCI (odds ratio (OR): 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups.
LM revascularisation activity has significantly declined during the COVID period, with a shift towards PCI as the preferred strategy. Postprocedural mortality within each revascularisation group was similar in the pre-COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularisation activity to pre-COVID levels.
关于 COVID-19 大流行对左主干（LM）冠状动脉血运重建活动、血运重建策略选择和术后结果的影响，相关数据有限。
纳入了 2017 年 1 月 1 日至 2020 年 8 月 19 日期间在英格兰接受 LM 疾病（≥50%狭窄）冠状动脉血运重建的所有患者（n=22235），按时间阶段（COVID-19 前：2017 年 1 月 1 日至 2020 年 2 月 29 日；COVID-19 期间：2020 年 3 月 1 日至 2020 年 8 月 19 日）和血运重建策略（经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG））分层。采用 logistic 回归模型，检验 COVID-19 期间（与 COVID-19 前相比） 1）接受 CABG（与 PCI 相比）的可能性，以及 2）院内和术后 30 天死亡率的比值比（OR）。
与前几年（2017-2019 年）的平均值相比，2020 年 3 月 1 日至 7 月 31 日期间 LM 血运重建手术减少了 1354 例（减少了 48.8%）。在 COVID-19 期间，观察到 PCI 的使用较 CABG 增加（接受 CABG 与 PCI：与 2017 年相比，OR 0.46 [0.39，0.53]），且在所有年龄组均一致。对于 PCI（院内死亡率：OR 0.72 [0.51. 1.02]；术后 30 天死亡率：OR 0.83 [0.62，1.11]）和 CABG（院内死亡率：OR 0.98 [0.45，2.14]；术后 30 天死亡率：OR 1.51 [0.77，2.98]）组，在 COVID-19 前和 COVID-19 期间，调整后的院内死亡率和术后 30 天死亡率无差异。
在 COVID-19 期间，LM 血运重建活动明显减少，PCI 作为首选策略的趋势增加。在每个血运重建组中，术后死亡率在 COVID-19 前和 COVID-19 期间相似，反映了大流行期间维持了治疗结果的质量。需要采取未来措施，以安全地将 LM 血运重建活动恢复到 COVID-19 前的水平。
