Percutaneous coronary intervention during the COVID-19 pandemic in Japan: Insights from the nationwide registration data

Background Coronavirus disease 2019 (COVID-19) has negatively affected access to healthcare systems and treatment timelines. This study was designed to explore the impact of the COVID-19 pandemic on patients who underwent percutaneous coronary intervention (PCI). Methods From January 2019 to December 2020, 489,001 patients from 1068 institutions were registered in the Japanese nationwide PCI (J-PCI) registry. We constructed generalized linear models to assess the difference in the daily number of patients and in-hospital outcomes between 2019 and 2020. Findings In total, 207 institutions (19.3%) had closed or restricted access during the first COVID-19 outbreak in May 2020; the number of closed or restricted institutions had plateaued at a median of 121 institutions (11. 3%). The daily case volume of PCI significantly decreased in 2020 (by 6. 7% compared with that in 2019; 95% confidence interval [CI], 6.2-7.2%; p < 0.001). Marked differences in the presentation of PCI patients were observed; more patients presented with ST-segment elevation myocardial infarction (18.3% vs. 17.5%; p < 0.001), acute heart failure (4.49% vs. 4.30%; p = 0.001), cardiogenic shock (3.79% vs. 3.45%; p < 0. 001), and cardiopulmonary arrest (2.12% vs. 2.00%; p = 0.002) in 2020. The excess adjusted in-hospital mortality rate in patients treated in 2020 relative to those treated in 2019 was significant (adjusted odds ratio, 1. 054; 95% CI, 1.004-1. 107; p = 0. 03). Interpretation While the number of patients who underwent PCI substantially decreased during the COVID-19 pandemic, more patients presented with high-risk characteristics and were associated with significantly higher adjusted in-hospital mortality. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.