TCT-66 Choice and Outcomes of Left Main Coronary Disease Revascularization Strategies in England Before and After the COVID-19 Era

Abstract

Background There are limited data on the impact of the COVID-19 pandemic on left main (LM) coronary revascularization activity, choice of strategy, and post-procedural outcomes. Methods All patients with LM disease (= 50% stenosis) undergoing coronary revascularization in England between January 1, 2017 and August 19, 2020 were included (n = 22,235), stratified by time period (pre-COVID: January 1, 2017 to February 29, 2020; COVID: March 1, 2020 to August 19, 2020) and revascularization strategy (percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). Logistic regression models were performed to examine odds ratio (OR) of receipt of CABG (vs percutaneous coronary intervention [PCI]) and in-hospital and 30-day postprocedural mortality in the COVID-19 period (vs pre-COVID). Results There was a decline of 1,354 LM revascularization procedures between March 1 and July 31, 2020 compared with previous years’ (2017 to 2019) averages (–48.8%). Increased use of PCI over CABG was observed in the COVID period (receipt of CABG vs PCI: OR 0.46 [0.39, 0.53] compared with 2017), consistent across all age groups. No difference in adjusted in-hospital or 30-day mortality was observed between pre-COVID and COVID periods for both PCI (OR: 0.72 [0.51. 1.02] and 0.83 [0.62, 1.11], respectively) and CABG (OR: 0.98 [0.45, 2.14] and 1.51 [0.77, 2.98], respectively) groups. Conclusion LM revascularization activity has significantly declined during the COVID period, with a shift toward PCI as the preferred strategy. Post-procedural mortality within each revascularization group was similar in the pre-COVID and COVID periods, reflecting maintenance in quality of outcomes during the pandemic. Future measures are required to safely restore LM revascularization activity to pre-COVID levels. Categories OTHER: Quality, Guidelines, Appropriateness Criteria, Cost-Effectiveness, and Public Health Issues