Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Florida, USA.
Department of Surgery, Geisinger Health System, Wilkes Barre, Pennsylvania, USA.
J Card Surg. 2022 Dec;37(12):4545-4551. doi: 10.1111/jocs.17085. Epub 2022 Nov 15.
There have been reported reductions of hospital presentation for acute cardiovascular conditions such as myocardial infarction and acute type A aortic dissection (ATAAD) in the United States during the COVID-19 pandemic. This study examined presentation patterns and outcomes of ATAAD in North America immediately before, and during, the COVID-19 pandemic.
The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD) was queried to identify patients presenting with ATAAD in the 12 months pre-pandemic (March 2019-February 2020), and during the early pandemic (March through June 2020). Demographics and operative characteristics were compared using χ² test and Wilcoxon Rank-sum test. The median annual case volume designated low-volume centers versus high-volume centers (>10 cases per month). Step-wise variable selection was used to create a risk set used for adjustment of all multivariable models.
There were 5480 patients identified: 4346 pre-pandemic and 1134 during pandemic. There was significantly lower volume of median cases per month during the COVID-19 pandemic period (286 interquartile range [IQR]: 256-306 vs. 372 IQR: 291-433,p = .0152). In historically low-volume centers (<10 cases per year), there was no difference in volume between the two periods (142 IQR: 133-166 vs. 177 IQR: 139-209, p = NS). In high-volume centers, there was a decline during the pandemic (140 IQR: 123-148 vs. 212 IQR: 148-224, p = .0052). There was no difference in overall hospital-to-hospital transfers during the two time periods (54% of cases pre-pandemic, 55% during). Patient demographics, operative characteristics, malperfusion rates, and cardiac risk factors were similar between the two time periods. There was no difference in unadjusted operative mortality (19.01% pre-pandemic vs. 18.83% during, p = .9) nor major morbidity (52.42% pre-pandemic vs. 51.24% during, p = .5). Risk-adjusted multivariable models showed no difference in either operative mortality nor major morbidity between time periods.
For patients presenting to the hospital with ATAAD during the first surge of the pandemic, operative outcomes were similar to pre-pandemic despite a 30% reduction in volume. Out-of-hospital mortality from ATAAD during the pandemic remains unknown. Further understanding these findings will inform management of ATAAD during future pandemics.
据报道，在美国 COVID-19 大流行期间，急性心血管疾病（如心肌梗死和急性 A 型主动脉夹层（ATAAD））的住院就诊率有所下降。本研究分析了 COVID-19 大流行前后北美 ATAAD 的就诊模式和结局。
通过胸外科医师学会成人心脏手术数据库（STS ACSD）查询在大流行前 12 个月（2019 年 3 月至 2020 年 2 月）和大流行早期（2020 年 3 月至 6 月）期间因 ATAAD 就诊的患者。使用卡方检验和 Wilcoxon 秩和检验比较人口统计学和手术特征。指定每年中位数病例量为低容量中心与高容量中心（每月>10 例）的分界线。逐步变量选择用于创建用于调整所有多变量模型的风险集。
共纳入 5480 例患者：大流行前 4346 例，大流行期间 1134 例。COVID-19 大流行期间每月中位数病例量明显减少（286 四分位距[IQR]：256-306 与 372 IQR：291-433，p=0.0152）。在历史上的低容量中心（每年<10 例），两个时期的病例量无差异（142 IQR：133-166 与 177 IQR：139-209，p=NS）。在高容量中心，大流行期间病例量下降（140 IQR：123-148 与 212 IQR：148-224，p=0.0052）。两个时期医院间转院率无差异（大流行前 54%，大流行期间 55%）。两个时期患者的人口统计学、手术特征、灌注不良率和心脏危险因素相似。未调整的手术死亡率无差异（大流行前 19.01%，大流行期间 18.83%，p=0.9），主要发病率也无差异（大流行前 52.42%，大流行期间 51.24%，p=0.5）。风险调整后的多变量模型显示，两个时期手术死亡率或主要发病率均无差异。
在大流行的第一波期间，因 ATAAD 住院就诊的患者，尽管手术量减少了 30%，但手术结局与大流行前相似。大流行期间因 ATAAD 导致的院外死亡率尚不清楚。进一步了解这些发现将有助于指导未来大流行期间对 ATAAD 的管理。
