The SARS-CoV-2 outbreak and its unpredictable course faced the world’s health care systems with a huge challenge. Driven by the potential shortage of high care hospital beds due to rapidly increasing numbers of SARS-CoV-2-infected, elective treatments were deferred. The impact of this measure on patients’ outcomes has not yet been assessed.
Purpose:
We set out to investigate the impact of the deferral of scheduled cardiac catheterizations on patients’ time to emergency cardiovascular hospitalization or death and clinical parameters.
Methods:
We performed a retrospective observational study including patients who were scheduled for elective left heart catheterization between March 19th and April 30th 2020, because of suspected coronary artery disease or disease progression as well as known residual coronary artery stenosis, whose elective appointment had been deferred during the initial phase of the COVID-19 pandemic (study group). Patients undergoing cardiac catheterization in the corresponding period of the previous year served as the control group. The primary endpoint was the time to emergency cardiovascular hospitalization or death. Secondary endpoints were clinical symptoms as measured by CCS-classification and cardiac biomarkers, such as high sensitive cardiac troponin T, as well as left ventricular systolic function.
Results:
Outcomes of 74 consecutive patients, whose elective left heart catheterization had been deferred and of 70 patients undergoing the procedure as scheduled in 2019, were compared. Interestingly, the primary endpoint showed a strong but non-significant trend towards a high rate of death or emergency cardiovascular hospitalization in the study group (HR 1.86 95% CI 0.94-3.67, p=0.069). Additionally, chest pain symptoms as measured by CCS-classification (study group: 0.5±1.1; control group: 0.3±0.8, p= 0.039) and serum troponin T levels (study group: 24 (10, 40) ng/l; control group 14 (7, 23) ng/l, p= 0.004) were significantly higher in the study group at the 12 months follow-up.
Conclusion:
The results of our study show that deferral of elective left heart catheterization procedures is accompanied by an increase in clinical symptoms and biomarkers of cardiac ischemia, indicating disease progression. Additionally, we observed a strong trend towards a higher rate of death or emergency cardiovascular hospitalizations, indicating that such interventions should not be deferred, if possible.
https://dgk.org/kongress_programme/ht2021/P90.htm