小柯机器人

英国纳菲尔德人口健康部Colin Baigent小组分析了COVID-19大流行期间，英国急性冠脉综合征的住院率和治疗管理。相关论文于2020年7月14日发表在《柳叶刀》杂志上。

几个受COVID-19大流行影响的国家报告称，急诊科患有急性冠状动脉综合症的患者数量大大减少，心脏手术数量减少。

为了了解英格兰不同类型的急性冠状动脉综合征入院变化的规模、性质和持续时间，并评估COVID-19大流行是否影响了患者的院内管理，研究组分析了2019年1月1日至2020年5月24日英格兰不同类型急性冠脉综合征的医院入院数据，包括ST段抬高型心肌梗死（STEMI）、非STEMI（NSTEMI）、未知类型的心肌梗死或其他急性冠状动脉综合征（包括不稳定型心绞痛）。研究组确定了这些患者入院期间进行的血运重建程序。

急性冠脉综合征的住院人数从2020年2月中旬开始下降，从2019年的基线每周3017例下降到2020年3月底的每周1813例，下降了40％。在2020年4月和5月期间，这种下降趋势部分逆转，到2020年5月的最后一周，有2522名患者入院，比基线减少了16％。在入院人数下降期间，包括STEMI和NSTEMI在内的所有类型的急性冠脉综合征的入院人数均有所减少，但NSTEMI相对和绝对减少幅度更大，2019年为每周1267例，2020年3月底为每周733例，减少了42％。

同时，STEMI和NSTEMI患者的PCI手术数量亦有所减少，与2019年相比，2020年3月底时，STEMI的PCI手术减少了21%，NSTEMI减少了37%。急性冠脉综合征患者的中位住院时间从2019年的4天下降到2020年3月底的3天。

总之，与2019年相比，2020年3月底英国急性冠状动脉综合征的住院人数大幅减少，到2020年5月底又略有增加。在此期间住院人数的减少，可能会导致院外死亡和心肌梗死长期并发症的增加，并错过为冠心病患者提供二级预防治疗的机会。

附：英文原文

Title: COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England

Author: Marion M Mafham, Enti Spata, Raphael Goldacre, Dominic Gair, Paula Curnow, Mark Bray, Sam Hollings, Chris Roebuck, Chris P Gale, Mamas A Mamas, John E Deanfield, Mark A de Belder, Thomas F Luescher, Tom Denwood, Martin J Landray, Jonathan R Emberson, Rory Collins, Eva J A Morris, Barbara Casadei, Colin Baigent

Issue&Volume: 2020-07-14

Abstract: Background

Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic.

Methods

We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous coronary intervention [PCI], PCI, and coronary artery bypass graft surgery). We calculated the numbers of weekly admissions and procedures undertaken; percentage reductions in weekly admissions and across subgroups were also calculated, with 95% CIs.

Findings

Hospital admissions for acute coronary syndrome declined from mid-February, 2020, falling from a 2019 baseline rate of 3017 admissions per week to 1813 per week by the end of March, 2020, a reduction of 40% (95% CI 37–43). This decline was partly reversed during April and May, 2020, such that by the last week of May, 2020, there were 2522 admissions, representing a 16% (95% CI 13–20) reduction from baseline. During the period of declining admissions, there were reductions in the numbers of admissions for all types of acute coronary syndrome, including both STEMI and NSTEMI, but relative and absolute reductions were larger for NSTEMI, with 1267 admissions per week in 2019 and 733 per week by the end of March, 2020, a percent reduction of 42% (95% CI 38–46). In parallel, reductions were recorded in the number of PCI procedures for patients with both STEMI (438 PCI procedures per week in 2019 vs 346 by the end of March, 2020; percent reduction 21%, 95% CI 12–29) and NSTEMI (383 PCI procedures per week in 2019 vs 240 by the end of March, 2020; percent reduction 37%, 29–45). The median length of stay among patients with acute coronary syndrome fell from 4 days (IQR 2–9) in 2019 to 3 days (1–5) by the end of March, 2020.

Interpretation

Compared with the weekly average in 2019, there was a substantial reduction in the weekly numbers of patients with acute coronary syndrome who were admitted to hospital in England by the end of March, 2020, which had been partly reversed by the end of May, 2020. The reduced number of admissions during this period is likely to have resulted in increases in out-of-hospital deaths and long-term complications of myocardial infarction and missed opportunities to offer secondary prevention treatment for patients with coronary heart disease. The full extent of the effect of COVID-19 on the management of patients with acute coronary syndrome will continue to be assessed by updating these analyses.

DOI: 10.1016/S0140-6736(20)31356-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31356-8/fulltext

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