COVID-19 pandemic and coronary angiography for ST-elevation myocardial infarction, use of mechanical support and mechanical complications in Canada; a Canadian Association of Interventional Cardiology national survey

Rinfret, Stéphane; Jahan, Israth; McKenzie, Kevin; Dendukuri, Nandini; Bainey, Kevin R; Mansour, Samer; Natarajan, Madhu; Ybarra, Luiz F; Chong, Aun-Yeong; Bérubé, Simon; Breton, Robert; Curtis, Michael J; Rodés-Cabau, Josep; Amlani, Shy; Bagherli, Alireza; Ball, Warren; Barolet, Alan; Beydoun, Hussein K; Brass, Neil; Chan, Albert W; Colizza, Franco; Constance, Christian; Fam, Neil P; Gobeil, François; Haghighat, Tinouch; Hodge, Steven; Joyal, Dominique; Kim, Hahn Hoe; Lutchmedial, Sohrab; MacDougall, Andrea; Malik, Paul; Miner, Steve; Minhas, Kunal; Orvold, Jason; Palisaitis, Donald; Parfrey, Brendan; Potvin, Jean-Michel; Puley, Geoffrey; Radhakrishnan, Sam; Spaziano, Marco; Tanguay, Jean-François; Vijayaraghaban, Ram; Webb, John G; Zimmermann, Rodney H; Wood, David A; Brophy, James M

Background As a result of the COVID-19 pandemic first wave, reductions in STEMI invasive care ranging from 23% to 76% have been reported from various countries. Whether it had any impact on coronary angiography (CA) volume or on mechanical support device use for ST-elevation myocardial infarction (STEMI) and post-STEMI mechanical complications in Canada is unknown. Methods We administered a Canada-wide survey to all Cardiac Catheterization Laboratory Directors seeking the volume of CA for STEMI performed during 01/03/2020-31/05/2020 (pandemic period) and from two control periods (01/03/2019-31/05/2019 and 01/03/2018-31/05/2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects or papillary muscle rupture cases diagnosed, were also recorded. We also assessed if the number of COVID-19 cases recorded in each province was associated with STEMI CA volume. Results Forty-one out of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (Incidence Rate Ratio or IRR 0.84; 95%CI 0.80-0.87) in CA for STEMI during the first wave of the pandemic compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95%CI 0.61-0.89) in the use of intra-aortic balloon pump in STEMI. Use of Impella® and mechanical complications from STEMI were exceedingly rare. Conclusion We observed a modest 16% decrease in CA for STEMI during the pandemic first wave in Canada, lower than reported in other countries. Provincial COVID-19 caseload did not influence this reduction.