Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Clin Res Cardiol. 2024 Jul;113(7):1041-1050. doi: 10.1007/s00392-024-02380-y. Epub 2024 Mar 6.
Patients, whose non-emergency cardiac procedure was postponed during the COVID-19 pandemic, have shown signs of disease progression in the short term. Data on the long-term effects are currently lacking.
To assess outcomes through 3 years following deferral.
This retrospective, single-center analysis includes consecutive patients whose non-emergency cardiovascular intervention was postponed during the first COVID-19-related lockdown (March 19 to April 30, 2020). Outcomes over 36 months post-procedure were analyzed and compared to a seasonal control group undergoing non-emergency intervention in 2019 as scheduled (n = 214). The primary endpoint was a composite of emergency cardiovascular hospitalization and death. Additionally, NT-proBNP levels were analyzed.
The combined endpoint occurred in 60 of 178 patients (33.7%) whose non-emergency transcatheter heart valve intervention, rhythmological procedure, or left heart catheterization was postponed. Primary endpoint events did not occur more frequently in the study group during the 36-month follow-up (p = 0.402), but within the first 24 months post-procedure (HR 1.77, 95% CI 1.20-2.60, p = 0.003). Deferred patients affected by an event in the postprocedural 24 months had significantly higher NT-proBNP levels at the time of intervention (p < 0.001) (AUC 0.768, p = 0.003, optimum cut-off 808.5 pg/ml, sensitivity 84.2%, specificity 65.8%) and thereafter (p < 0.001).
Deferral of non-emergency cardiovascular interventions is associated with poor outcomes up to 24 months post-procedure. Adverse effects affect patients who develop signs of acute heart failure, as indicated by NT-proBNP, prior to treatment. These findings could help improve resource allocation in times of limited capacity.
在 COVID-19 大流行期间，非紧急心脏手术的患者在短期内出现疾病进展的迹象。目前缺乏关于长期影响的数据。
评估推迟后 3 年的结果。
这是一项回顾性、单中心分析，纳入了在第一次 COVID-19 相关封锁期间（2020 年 3 月 19 日至 4 月 30 日）推迟非紧急心血管介入治疗的连续患者。分析了术后 36 个月的结果，并与按计划在 2019 年接受非紧急介入治疗的季节性对照组（n=214）进行比较。主要终点是紧急心血管住院和死亡的复合终点。此外，还分析了 NT-proBNP 水平。
178 例非紧急经导管心脏瓣膜介入、节律程序或左心导管检查患者中，有 60 例（33.7%）发生了联合终点事件。在 36 个月的随访期间，研究组的主要终点事件发生率并没有更高（p=0.402），但在术后 24 个月内发生率更高（HR 1.77，95%CI 1.20-2.60，p=0.003）。在术后 24 个月发生事件的延迟患者在干预时的 NT-proBNP 水平显著更高（p<0.001）（AUC 0.768，p=0.003，最佳截断值 808.5pg/ml，敏感性 84.2%，特异性 65.8%），此后亦然（p<0.001）。
非紧急心血管介入治疗的延迟与术后 24 个月内的不良结局相关。不良影响影响到那些在治疗前出现急性心力衰竭迹象的患者，这可以通过 NT-proBNP 来指示。这些发现可以帮助在资源有限的情况下改善资源分配。
