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

Eur Heart J. 2020 Jun 7;41(22):2083-2088. doi: 10.1093/eurheartj/ehaa409.

Abstract

Aims: To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs).

Methods and results: We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7-32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3-70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7-6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1-2.8; P = 0.009).

Conclusion: Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.

Keywords: Acute myocardial infarction; COVID-19; Cardiac care units; SARS-CoV2; STEMI.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Coronavirus Infections*
  • Female
  • Hospitalization / trends*
  • Humans
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / diagnosis
  • Myocardial Infarction* / mortality
  • Myocardial Infarction* / therapy
  • Pandemics*
  • Pneumonia, Viral*
  • SARS-CoV-2