Return towards normality in admissions for myocardial infarction after the lockdown removal for COVID-19 outbreak in Italy

Abstract

Background: Investigations demonstrated a decrease of admissions for myocardial infarction (MI) during the Co-ronaVirus outbreak. No study has evaluated the time required to reverse this downward curve of MI admissions. Methods: This is a retrospective analysis on patients (N = 2415) admitted to the Emergency Departments for acute MI in nine Italian centers. Primary endpoint was the incidence rates (IRs) of MI admissions in the postlockdown COVID-19 period (case-period: from May 4 to July 12, 2020) vs. the following control periods: January 1-February 19, 2020 (pre-lockdown period); February 20-May 3, 2020 (intra-lockdown period); May 4-July 12, 2019 (inter-year non-COVID-19 period). Results: IR of admissions for MI in the post-lockdown period was higher than the intra-lockdown period (IR ratio, IRR: 1.60, 95% CI 1.42-1.81; p = 0.0001), was lower than the pre-lockdown period (IRR: 0.86, 0.77-0.96; p = 0.009) and similar to the inter-year non-COVID-19 period (IRR: 0.96, 0.87-1.07; p = 0.47). Within the case period, the increase in MI admissions was more pronounced in earlier vs later weeks (IRR 1.19, 95% CI 1.02-1.38, p = 0.024) and, compared to the inter-year control period, was significant for non ST-segment elevation MI (IRR: 1.25, 95% CI 1.08-1.46, p = 0.004), but was not observed for ST-segment elevation MI (STEMI), where hospitalizations were reduced (IRR 0.76, 95% CI 0.65-0.88, p = 0.0001). Conclusions: Our study first indicates an increase in the number of admissions for MI after the removal of the national lockdown for COVID-19 in Italy. This increase was prevalent in the first weeks following the lockdown removal, but was under-represented in STEMI patients.

Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data

“…Note that only in Lombardy, an increase in mortality from ischemic heart disease was registered during the first epidemic wave. A decline in hospital admissions for myocardial infarction was registered during the lockdown in Italy; patients with minor symptoms probably avoided or delayed access to the Emergency Department due to social isolation and fear of contagion within hospitals [ 34 ]. Such further barriers to timely care, possibly increasing out-of-hospital cardiovascular mortality and worsening prognosis of hospitalized patients, were likely stronger in areas with higher COVID-19 incidence.…”

Type of hospitalisations and in-hospital outcomes in the Italian coronary care unit network at the time of COVID-19 pandemic: the BLITZ-COVID19 Registry

“…This could have impacted on the process of care and related outcomes, although we observed a greater use of revascularisation procedures in ACS compared with previous Italian or European registries 4 5 19 20. Indeed, a retrospective analysis on patients admitted to the emergency departments for AMI in nine Italian centres, documented an increase in the number of admissions for AMI after the removal of the national lockdown for COVID-19 in Italy, especially in the first weeks following the lockdown removal 21…”

“… 4 5 19 20 Indeed, a retrospective analysis on patients admitted to the emergency departments for AMI in nine Italian centres, documented an increase in the number of admissions for AMI after the removal of the national lockdown for COVID-19 in Italy, especially in the first weeks following the lockdown removal. 21 …”

“…4 5 19 20 Indeed, a retrospective analysis on patients admitted to the emergency departments for AMI in nine Italian centres, documented an increase in the number of admissions for AMI after the removal of the national lockdown for COVID-19 in Italy, especially in the first weeks following the lockdown removal. 21 Although in previous studies of hospitalised patients with COVID-19 the concomitant presence of chronic cardiac disease was significantly associated with mortality, in a recent multinational patient registry specifically established to determine the role of cardiovascular diseases in the COVID-19 pandemic, only those with heart failure were at greatest risk of in-hospital death. 22 23 Since in our study the main diagnosis of heart failure was present in a minority of our COVID-19 patients (6%), it could explain the relative impact of COVID-19 on the overall mortality observed in our series.…”

Observational Study on Chest Pain During the Covid-19 Pandemic: Changes and Characteristics of Visits to a Norwegian Emergency Department During the Lockdown.

“…According to Mafham et al, weekly ACS admissions had approximately recovered by August [17], a month later than in our data. In both Italy and Germany, the admissions and prevalence of acute myocardial infarction normalized in May [5,20]. Considering that the delayed normalization in England also is seen for all acute myocardial infarction admissions (not only in the total ACS population) [17], it is likely that there is a genuine difference in the timing of normalization.…”