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Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era

De Rosa S, Spaccarotella C, Basso C, et. al. European Heart Journal, ehaa409, 

Background:

Early in the 2020 COVID – 19 outbreak, one-week acute myocardial infarction (AMI) nationwide data from 44 Italian hospitals were compared to the equivalent week in 2019.

Key Points:

  • Admissions were reduced for AMI (48.4%, p < 0.001); STEMI (26.5%, p < 0.009) and NSTEMI (65.1%, p < 0.001).
  • Mortality increased for all groups: AMI – 2.8 to 9.7% (p < 0.001); For STEMI – 4.1 to 13.7% (p < 0.001) for NSTEMI; 1.7% to 3.3% (P = NS).
  • Similarly, ICU Heart Failure admissions were reduced by nearly half (46.8%, P = 0.005) in 2020.
  • Major AMI complications (cardiogenic shock, life-threatening arrhythmias, and cardiac rupture/ventricular septal defect (VSD) or severe functional mitral regurgitation) doubled from 7.4% in 2019 to 15.7% in 2020 (p = 0.001).
  • Reductions in STEMI admissions were less significantly less for women (41.2%, P + 0.011) while for men admissions were less, but not significantly (17.8% P + 0.191).
  • The rate of coronary angiography for STEMI patients was similar for both years – 94.5% vs. 94.9%, P = NS).
  • NSTEMI PCI decreased 13.3% (P = 0.023) from 76.7% of patients in 2019 to 66.1% of patients in 2020.
  • 7% of STEMI patients were COVID – 19 positive, with high mortality rate (28.6%), but despite this high rate for the COVID – 19 positive patients, the mortality for non-infected STEMI patients remained significantly higher for 2020 compared to 2019 (P = 0.018).
  • Stated but not numerically documented, the time of first medical contact to PCI was much greater in 2020, emphasizing time to revascularization as well as primary PCI are critical factors.

 

Summary

The authors note that not only were the in-hospital death and complication rates higher among AMI patients but the surviving, untreated AMI patients likely represent a major risk for delayed complex requirements for revascularization and treatment for heart failure.