Abstract：
BACKGROUND: Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described.
METHODS: We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods.
RESULTS: The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026).
CONCLUSIONS: Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.
METHODS: We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods.
RESULTS: The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026).
CONCLUSIONS: Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.
摘要：
背景：在2020年国际COVID-19封锁期间，急性冠状动脉综合征（ACS）入院和经皮冠状动脉介入治疗（PCI）量下降。封锁对紧急医疗服务(EMS)利用率的影响，澳大利亚大流行初期的PCI量尚未得到很好的描述。
方法：我们分析了维多利亚州心脏结果登记处（VCOR）的数据，全州PCI注册表，与维多利亚救护车EMS登记处联系。PCI卷,30天主要不良心血管和脑血管事件（MACCE；复合死亡率，心肌梗塞,支架内血栓形成,计划外血管再生,和中风)，和EMS利用率在四个时间段进行了比较：封锁(2020年3月26日至2020年5月12日)；封锁前(2020年2月26日至2020年3月25日)；封锁后(2020年5月13日至2020年7月10日)；和前一年(2019年3月26日至2019年5月12日)。进行了中断时间序列分析，以评估连续时间段内和之间的PCI趋势。
结果：与其他时期相比，锁定期间ACS的EMS利用率更高：锁定39.4％，锁定前29.7％；锁定后33.6％；与前一年的27.1％；所有p<0.01。每日PCI病例中位数相似：锁定期间31例（IQR10、38）；锁定前39例（15、49）；锁定后39.5例（11、44）；以及，42(10，49)；所有p>0.05。锁定期间ACS指示的平均门到手术时间在3小时(1.2,20.6)比锁定前3.9(1.7,21)更短;与锁定后3.5(1.5,21.26);和,前一年3.5（1.5，23.7）；所有p<0.05。与封锁前相比，封锁期30天MACCE的赔率较低（赔率比[OR]0.55[0.33-0.93]；p=0.026）；封锁后（OR0.66；[0.40-1.06]；p=0.087）；以及前一年（OR0.55[0.33-0.93]；p=0.026）。
结论：与国际趋势相反，ACS的EMS利用率在封锁期间有所增加，但在维多利亚州大流行的整个初始阶段，PCI量保持相似，在封锁期间对30天的MACCE没有观察到的不良反应。这些数据表明，维多利亚州的公共卫生反应与接受PCI的患者的心血管护理质量较差无关。
方法：我们分析了维多利亚州心脏结果登记处（VCOR）的数据，全州PCI注册表，与维多利亚救护车EMS登记处联系。PCI卷,30天主要不良心血管和脑血管事件（MACCE；复合死亡率，心肌梗塞,支架内血栓形成,计划外血管再生,和中风)，和EMS利用率在四个时间段进行了比较：封锁(2020年3月26日至2020年5月12日)；封锁前(2020年2月26日至2020年3月25日)；封锁后(2020年5月13日至2020年7月10日)；和前一年(2019年3月26日至2019年5月12日)。进行了中断时间序列分析，以评估连续时间段内和之间的PCI趋势。
结果：与其他时期相比，锁定期间ACS的EMS利用率更高：锁定39.4％，锁定前29.7％；锁定后33.6％；与前一年的27.1％；所有p<0.01。每日PCI病例中位数相似：锁定期间31例（IQR10、38）；锁定前39例（15、49）；锁定后39.5例（11、44）；以及，42(10，49)；所有p>0.05。锁定期间ACS指示的平均门到手术时间在3小时(1.2,20.6)比锁定前3.9(1.7,21)更短;与锁定后3.5(1.5,21.26);和,前一年3.5（1.5，23.7）；所有p<0.05。与封锁前相比，封锁期30天MACCE的赔率较低（赔率比[OR]0.55[0.33-0.93]；p=0.026）；封锁后（OR0.66；[0.40-1.06]；p=0.087）；以及前一年（OR0.55[0.33-0.93]；p=0.026）。
结论：与国际趋势相反，ACS的EMS利用率在封锁期间有所增加，但在维多利亚州大流行的整个初始阶段，PCI量保持相似，在封锁期间对30天的MACCE没有观察到的不良反应。这些数据表明，维多利亚州的公共卫生反应与接受PCI的患者的心血管护理质量较差无关。
