Impact of COVID-19 pandemic on STEMI care: An expanded analysis from the United States.

OBJECTIVE: To evaluate the impact of COVID-19 pandemic migitation measures on of ST-elevation myocardial infarction (STEMI) care. BACKGROUND: We previously reported a 38% decline in cardiac catheterization activations during the early phase of the COVID-19 pandemic mitigation measures. This study extends our early observations using a larger sample of STEMI programs representative of different US regions with the inclusion of more contemporary data. METHODS: Data from 18 hospitals or healthcare systems in the US from January 2019 to April 2020 were collecting including number activations for STEMI, the number of activations leading to angiography and primary percutaneous coronary intervention (PPCI), and average door to balloon (D2B) times. Two periods, January 2019-February 2020 and March-April 2020, were defined to represent periods before (BC) and after (AC) initiation of pandemic mitigation measures, respectively. A generalized estimating equations approach was used to estimate the change in response variables at AC from BC. RESULTS: Compared to BC, the AC period was characterized by a marked reduction in the number of activations for STEMI (29%, 95% CI:18-38, p \u3c .001), number of activations leading to angiography (34%, 95% CI: 12-50, p = .005) and number of activations leading to PPCI (20%, 95% CI: 11-27, p \u3c .001). A decline in STEMI activations drove the reductions in angiography and PPCI volumes. Relative to BC, the D2B times in the AC period increased on average by 20%, 95%CI (-0.2 to 44, p = .05). CONCLUSIONS: The COVID-19 Pandemic has adversely affected many aspects of STEMI care, including timely access to the cardiac catheterization laboratory for PPCI

Contemporary Natural History and Management of Nonobstructive Hypertrophic Cardiomyopathy

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MitraClip after failed surgical mitral valve repair: an international multicenter study

BackgroundRecurrence of mitral regurgitation (MR) after surgical mitral valve repair (SMVR) varies and may require reoperation. Redo mitral valve surgery can be technically challenging and is associated with increased risk of mortality and morbidity. We aimed to assess the feasibility and safety of MitraClip as a treatment strategy after failed SMVR and identify procedure modifications to overcome technical challenges.Methods and ResultsThis international multicenter observational retrospective study collected information for all patients from 16 high-volume hospitals who were treated with MitraClip after failed SMVR from October 29, 2009, until August 1, 2017. Data were anonymously collected. Technical and device success were recorded per modified Mitral Valve Academic Research Consortium criteria. Overall, 104 consecutive patients were included. Median Society of Thoracic Surgeons score was 4.5% and median age was 73 years. At baseline, the majority of patients (82%) were in New York Heart Association class >= III and MR was moderate or higher in 86% of patients. The cause of MR pre-SMVR was degenerative in 50%, functional in 35%, mixed in 8%, and missing/unknown in 8% of patients. The median time between SMVR and MitraClip was 5.3 (1.9-9.7) years. Technical and device success were 90% and 89%, respectively. Additional/modified imaging was applied in 21% of cases. An MR reduction of >= 1 grade was achieved in 94% of patients and residual MR was moderate or less in 90% of patients. In-hospital all-cause mortality was 2%, and 86% of patients were in New York Heart Association class <= II.ConclusionsMitraClip is a safe and less invasive treatment option for patients with recurrent MR after failed SMVR. Additional/modified imaging may help overcome technical challenges during leaflet grasping.Cardiolog

TCT-470 Incidence and Clinical Characteristics of Stroke in Patients Presenting With STEMI: Insights From the Midwest STEMI Consortium

Background: Contemporary real-world data on stroke in patients presenting with ST-segment elevation myocardial infarction (STEMI) are scarce. Methods: We evaluated the incidence and etiology of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We described the clinical characteristics and discharge data of stroke patients. Results: In total, 12,868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The stroke etiology was ischemic in 74.5%, hemorrhagic in 21.4%, and mixed in 3%. Most of the postprocedural strokes were identified \u3e24 hours after primary percutaneous coronary intervention (PCI) (43%). The median time to stroke symptoms after PCI was 14 hours (interquartile range: 4-72 hours). Stroke occurred before primary PCI in 13% of patients and during the procedure in 5%. On the basis of the review of medical records and neurology adjudication, the stroke etiology was determined to be procedure related, related to anoxic brain injury, or atrial fibrillation in 21%, 10%, and 7.1% of cases, respectively. A stroke after STEMI is associated with significantly higher in-hospital mortality (18%). Approximately 49.2% of patients who had in-hospital strokes were discharged to nursing facilities or assisted living facilities. Conclusion: In patients presenting with STEMI, the risk for stroke is low (0.76%). One in 5 strokes associated with STEMI was hemorrhagic, and approximately 1 in 10 patients had their strokes before PCI. A stroke after STEMI is associated with significantly higher in-hospital mortality (18%) and half of the survivors were discharged to a facility