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Sawano, M

市病・循環器内科

Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College,
Available from http://ir.tdc.ac.jp/
Title COVID-19 and Coronary Intervention in Japan
Author(s)
Alternative
Sawano, M
Journal
Journal of atherosclerosis and thrombosis, 29(11):
1563-1564
URL http://hdl.handle.net/10130/6105
Right
Copyright©2022 Japan Atherosclerosis Society This
article is distributed under the terms of the
latest version of CC BY-NC-SA defined by the
Creative Commons Attribution License.
Description
The official journal of the Japan Atherosclerosis Society and 
the Asian Pacific Society of Atherosclerosis and Vascular Diseases
J Atheroscler Thromb, 2022; 29: 1563-1564.   http://doi.org/10.5551/jat.ED198Editorial
1563
Copyright©2022 Japan Atherosclerosis Society
This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.
See article vol. 29: 1571-1587
The coronavirus disease 2019 (COVID-19) 
pandemic has had a detrimental impact on the 
healthcare system that was confronted by an 
overwhelming number of infected patients as well as a 
shortage of healthcare workers, especially in the acute 
care setting. Acute myocardial infarction (AMI) is one 
of the most common and representative diseases that 
require prompt treatment via thrombolysis or more 
preferably via coronary revascularization with 
percutaneous coronary intervention (PCI) or coronary 
artery bypass surgery. In the prepandemic world, 
achieving a door-to-balloon time of under 90 minutes 
for PCI cases had been widely accepted as a quality 
metric because early treatment can reduce in-hospital 
mortality1). However, achieving such a goal has 
become a major challenge due to the necessary but 
rigorous protocols established to mitigate the risk of 
infection. To address these issues, major academic 
societies from the United States and Japan have 
proposed modified strategies for coronary 
revascularization2, 3). The impact of the COVID-19 
pandemic on AMI care differed largely among 
countries. In China, changes in access to care, delays 
in treatment timelines, changes in reperfusion 
strategies, and an increase in in-hospital mortality and 
heart failure in patients with ST-elevation myocardial 
infarction (STEMI) were observed from an earlier 
phase of the pandemic4). In the United States, a 
concomitant diagnosis of COVID-19 was significantly 
associated with higher rates of in-hospital mortality 
compared with patients without a diagnosis of 
COVID-19 from the year 2019 5). A serial nationwide 
survey (in mid-April, late-April, and mid-May 2020) 
conducted by the Japanese Association of 
Cardiovascular Intervention and Therapeutics 
demonstrated that most hospitals opted to perform 
primary PCI in the usual manner at the beginning of 
the pandemic; however, as the pandemic progressed, 
hospitals in populated areas transiently withheld the 
number of PCIs for chronic coronary syndrome and 
high-risk acute coronary syndrome indications but not 
for STEMI cases. After the lockdown was lifted in 
most prefectures in mid-May, the number of PCIs 
gradually recovered to its normal value6). Furthermore, 
COVID-19 screening tests were performed at a 
significantly higher rate during the third wave than 
during the second wave, and personal protective 
equipment were more widely available over time7). A 
recent study by Watanabe et al. is aligned with the 
survey results and provides evidence on how Japanese 
PCI hospitals were able to maintain the standard level 
of care, especially after the third wave of the pandemic. 
Watanabe et al. performed an interrupted time series 
analysis using the Diagnosis Procedure Combination 
administrative database from April 2018 to February 
2021 8). Their study was important because they 
quantitatively demonstrated care and outcomes of 
patients with coronary heart disease and supplemented 
qualitative studies to understand the possible reasons 
that Japan was able to outlast the potentially harmful 
impact of the pandemic. Collaborations between 
administrative databases, clinical registries, patient-
reported outcomes as well as surveys are warranted to 
understand the true impact of the pandemic and build 
a resilient healthcare system to confront future 
pandemics.
Conflicts of Interest
None.
References
1) McNamara RL, Wang Y, Herrin J, Curtis JP, Bradley EH, 
Magid DJ, Peterson ED, Blaney M, Frederick PD, 
Address for correspondence: Mitsuaki Sawano, Tokyo Dental College Ichikawa General Hospital, Department of Cardiology, Chiba, Japan      
E-mail address: mitsuakisawano@gmail.com 
Received: February 21, 2022      Accepted for publication: February 21, 2022
COVID-19 and Coronary Intervention in Japan
Mitsuaki Sawano
Tokyo Dental College Ichikawa General Hospital, Department of Cardiology, Chiba, Japan
1564
Mitsuaki Sawano
Cardiol, 2020; 76: 1318-1324
5) Saad M, Kennedy KF, Imran H, Louis DW, Shippey E, 
Poppas A, Wood KE, Abbott JD, Aronow HD. 
Association Between COVID-19 Diagnosis and 
In-Hospital Mortality in Patients Hospitalized With 
ST-Segment Elevation Myocardial Infarction. JAMA, 
2021; 326: 1940-1952
6) Ishii H, Amano T, Yamaji K, Kohsaka S, Yokoi H, Ikari Y. 
Implementation of Percutaneous Coronary Intervention 
During the COVID-19 Pandemic in Japan - Nationwide 
Survey Report of the Japanese Association of Cardiovascular 
Intervention and Therapeutics for Cardiovascular Disease. 
Circ J, 2020; 84: 2185-2189
7) Ishii H, Amano T, Kohsaka S, Morino Y, Yokoi H, Ikari Y. 
National survey of percutaneous coronary intervention 
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of the Japanese Association of Cardiovascular Intervention 
and Therapeutics. Cardiovasc Interv Ther, 2021; 1-5
8) Watanabe S, Shin JH, Morishita T, Takada D, Kunisawa 
S, Imanaka Y. Medium-Term Impact of the Coronavirus 
Disease 2019 Pandemic on the Practice of Percutaneous 
Coronary Interventions in Japan. J Atheroscler Thromb, 
2022; 29: 1571-1587
Krumholz HM. Effect of door-to-balloon time on 
mortality in patients with ST-segment elevation 
myocardial infarction. J Am Coll Cardiol, 2006; 47: 
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2) Mahmud E, Dauerman HL, Welt FGP, Messenger JC, 
Rao S V, Grines C, Mattu A, Kirtane AJ, Jauhar R, Meraj 
P, Rokos IC, Rumsfeld JS, Henry TD. Management of 
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Pandemic: A Position Statement From the Society for 
Cardiovascular Angiography and Interventions (SCAI), 
the American College of Cardiology (ACC), and the 
American College of Emergency Physici. J. Am. Coll. 
Cardiol., 2020; 76: 1375-1384
3) Ikari Y, Yamada S, Ehara N, Kozuma K, Shinke T, Sugano 
T, Seike F, Sonoda S, Tazaki J, Tsuji T, Mibiki Y, 
Muramatsu T, Morita T, Sawano M. The Japanese 
Association of Cardiovascular Intervention and 
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Cardiovasc Interv Ther, 2021; 36: 139-144
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Huang K, Su X, Yu B, Wang Y, Fang W, Huo Y, Ge J. 
Management and Outcomes of Patients With STEMI 
During the COVID-19 Pandemic in China. J Am Coll 


COVID-19 and Coronary Intervention in Japan

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