Population Trends in Rates of Percutaneous Coronary Revascularization for Acute Coronary Syndromes Associated With the COVID-19 Outbreak
Raffaele Piccolo, Dario Bruzzese, Ciro Mauro, A Aloia, Cesare Baldi, Marco Boccalatte, G Bottiglieri, Carlo Briguori, Gianluca Caiazzo, Paolo Calabrò, Maurizio Cappelli-Bigazzi, Ciro De Simone, Emilio Di Lorenzo, Paolo Golino, Vittorio Monda, Rocco Perrotta, Gaetano Quaranta, Enrico Russolillo, Marino Scherillo, Tullio Tesorio, Bernardino Tuccillo, Giuseppe Valva, Bruno Villari, Giuseppe Tarantini, Attilio Varricchio, Giovanni Esposito, Marisa Avvedimento, R Bianchi, Stefano Capobianco, Gerardo Carpinella, Mario Crisci, Luca Esposito, Luciano Fattore, Luigi Fimiani, Dario Formigli, Marco Golino, Eugenio Laurenzano, Attilio Leone, Fabio Magliulo, Tullio Niglio, Roberto Padalino, Fabio Pastore, Federica Serino, Fortunato Scotto di Uccio, Gabriella Visconti
Abstract
◼ percutaneous coronary interventionA reduction in hospital admissions for acute coronary syndromes (ACS) has been observed globally in the aftermath of the pneumonia outbreak caused by coronavirus disease 2019 (COVID-19). 1 Despite the emergence of anecdotal reports, formal evaluation of the variation in percutaneous coronary intervention (PCI) rates during the COVID-19 outbreak has not yet been reported.Italy is one of the countries most heavily affected by the COVID-19 pandemic with 168 941 confirmed cases and 22 170 deaths as of April 5, 2020.We investigated the association between the outbreak of COVID-19 and PCI rates for ACS in the Campania region, which, with 5.8 million residents, represents ≈10% of the Italian population.Data were obtained from 20 of 21 PCI centers over an 8-week period, including 4 weeks before and 4 weeks after the COVID-19 outbreak corresponding with the first reported case declared by the Civil Protection Department on February 27, 2020.Incidence rates and their ratios were calculated by using Poisson regression analysis, and interactions for sex and age were estimated by adding the interaction term to the regression models. 2Population denominators, which were used as offset, were obtained from the Italian census.The ratio change in PCI rates for the entire 8-week interval was estimated by adding a linear term to the Poisson regression.The study was approved by the Ethics Committee of the University of Naples Federico II (Naples, Italy).From January 30, 2020, to March 26, 2020, a total of 1831 PCIs were performed in the Campania region; of them, 738 (40.31%) were elective PCIs (not included), 604 (32.99%) were PCIs for non-ST-segment-elevation acute ACS, and 489 (26.71%) were PCIs for ST-segment-elevation myocardial infarction (STEMI).Mean age was 65.7 years (SD, 12), and 804 of 1093 PCIs (73.56%) were performed in men.There were no differences in mean age (65.8±11.8versus 65.6±12.2years, P=0.78) and the proportion of men (72% versus 75%, P=0.29) in the 4 weeks before the COVID-19 outbreak in comparison with the subsequent 4 weeks.The incidence rate of PCI for ACS decreased from 178 to 120 cases per 100 000 residents per year during the 4-week period before in comparison with after the COVID-19 outbreak (Figure).The incidence rate ratio (IRR) was 0.68.The reduction was similar for both non-ST-segment-elevation ACS and STEMI (from 98 to 66 and from 80 to 54 PCI cases per 100 000 residents per year, respectively).The decrease in PCIs for ACS was more evident in women (IRR, 0.60) than in men (IRR, 0.70), resulting in a significant interaction (P<0.001).There was heterogeneity (P-interaction <0.001) in the decline of PCI rates across age categories, with patients <55 years of age less affected by the reduction (IRR, 0.75).Findings were consistent between PCI centers in the metropolitan (IRR, 0.72) versus nonmetropolitan areas (IRR, 0.62).Over the interval from week -4 to week +4, the ratio change in PCI rate was 0.51 (95% CI, 0.50-0.52)for ACS, 0.54 (95% CI, 0.53-0.56)for non-ST-segment-elevation acute ACS,