TCT CONNECT-221 Primary PCI for STEMI During the COVID-19 Pandemic in London: A Systematic Analysis of Pathway Activation and Outcomes

Background: Coronavirus disease-2019 (COVID-19) poses a risk for health care workers necessitating modifications to existing medical pathways In particular, managing patients with suspected COVID-19 represents a risk to the delivery of a primary percutaneous coronary intervention (PPCI) pathway where time-dependent revascularization is key Methods: We sought to evaluate the effect of the COVID-19 pandemic on an established ambulance-triggered PPCI program involving 2 high-volume heart attack centers in London, United Kingdom A systematic analysis was performed in patients with ST-segment elevation myocardial infarction undergoing PPCI comparing the COVID-19 pandemic period March 1, 2020, to April 30, 2020, with a control group from the previous year Results: During the study period, admissions through the PPCI pathway decreased by 34% The time from symptoms onset to first call for help (2020: 11 min vs 2019: 12 min;p = 0 90) and from symptom onset to arrival at PPCI center (2020: 183 min vs 2019: 178 min;p = 0 99) were comparable;however, the time from arrival at PPCI center to revascularization decreased (2020: 44 min vs 2019: 53 min;p = 0 0004) In-hospital mortality during the study period was significantly lower (5% vs 15%;p = 0 04) COVID-19–positive patients (n = 8) had higher rates of cardiogenic shock (25%), intensive care unit admission (50%), and inpatient mortality (38%) [Formula presented] Conclusion: Our data show that the modifications to the existing PPCI pathway were not associated with treatment delay or adverse outcome The reduction in ST-segment elevation myocardial infarction presentations raises concern that patients may not be seeking appropriate medical attention for chest pain Importantly, we demonstrate that PPCI can be delivered safely and efficiently during the COVID-19 pandemic Categories: OTHER: COVID-19