The missing acute coronary syndromes in the COVID-19 era
Neil Ruparelia1, Vasileios Panoulas2,3
1Department of Cardiology, Royal Berkshire Hospital, London Road, Reading, Berkshire, RG1 5AN, UK.
Insights
The number of acute coronary syndrome cases, including ST elevation myocardial infarctions (STEMI) and non-ST elevation myocardial infarctions (NSTEMI), significantly decreased during the COVID-19 pandemic. This decline in heart attack presentations coincided with public health measures promoting social distancing.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has led to unprecedented public health measures, including social distancing and lockdowns.
- Understanding the impact of these measures on non-COVID-19 related medical emergencies is crucial for healthcare planning.
Purpose of the Study:
- To investigate the trend in acute coronary syndrome (ACS) presentations during the COVID-19 pandemic.
- To compare ACS incidence before and after the implementation of social distancing measures in the UK.
Main Methods:
- Retrospective analysis of primary percutaneous coronary intervention (PPCI) activations, ST elevation myocardial infarctions (STEMI), and non-ST elevation myocardial infarctions (NSTEMI) data.
- Comparison of weekly case numbers from 2019 with those in early 2020, before and after COVID-19 restrictions.
- Data collected from two large hospitals in Greater London.
Main Results:
- No significant difference in myocardial infarction (MI) rates was observed in early 2020 compared to 2019 before social distancing measures.
- A significant reduction in all MIs occurred following increased public awareness and media reporting of COVID-19.
- STEMI, NSTEMI, and overall MI figures remained significantly reduced after the UK government mandated strict social distancing and stay-at-home orders.
Conclusions:
- A substantial decline in acute coronary syndrome presentations and treatments was observed during the COVID-19 pandemic.
- Nationwide public health measures emphasizing social distancing appear to have contributed to this unexpected decrease in ACS cases.
Aims:
To determine whether the number of patients presenting with acute coronary syndromes has reduced during the COVID-19 pandemic.
Methods:
Numbers of primary percutaneous coronary intervention (PPCI) activations, ST elevation myocardial infarctions (STEMIs) and non-ST elevation myocardial infarctions (NSTEMIs) in a large tertiary Greater London centre and a large district general hospital, both of which have on-site heart attack centres, were collected. We compared the number of PPCI activations, STEMI, NSTEMIs and all MIs prior to the COVID-19 era (January to third week of February 2020), after the start of some COVID-19 restrictions taking place (fourth week of February 2020) and after formal instruction by the United Kingdom Government that all citizens were to observe strict social distancing measures (20 March 2020). We further obtained data for the corresponding weekly figures from 2019.
Results:
The average weekly figure of all myocardial infarction in 2020, prior to the COVID-19 social distancing restrictions/awareness in the UK (beginning of January to third week of February), did not differ when compared with corresponding weeks in 2019 (23.3 ± 5.4 in 2019 versus 21.13 ± 3.5, p = 0.411).With increased media reporting and associated public awareness of the threat of COVID-19 (last week of February), there was a significant reduction in all myocardial infarction (27.1 ± 4.7 in 2019 versus 15.9 ± 3.6 in 2020, p < 0.001). Following official governmental instruction that mandated strict social distancing and the 'stay at home' campaign, the weekly figures of STEMI (15 ± 3.5 in 2019 versus 10 ± 4.4 in 2020, p = 0.013), NSTEMI (13 ± 2.6 in 2019 versus 4.7 ± 2.3 in 2020, p = 0.038) and all myocardial infarction (28 ± 6.1 in 2019 versus 14.7 ± 5.7 in 2020, p = 0.008) have remained significantly reduced.
Conclusion:
We have observed an unexpected major decline in presentations (and treatment) of the entire spectrum of acute coronary syndromes following the beginning of the COVID-19 pandemic and nationwide public-health measures that have promoted the importance of strict social distancing and self-quarantine.
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