Return towards normality in admissions for myocardial infarction after the lockdown removal for COVID-19 outbreak in
Andrea Rognoni1, Fabrizio D'Ascenzo2, Martina Solli1
1Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy.
Insights
Myocardial infarction (MI) admissions increased post-lockdown in Italy, particularly in the initial weeks. However, ST-segment elevation MI (STEMI) hospitalizations remained reduced, indicating a complex recovery pattern.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic led to decreased hospital admissions for myocardial infarction (MI).
- The temporal trends and recovery patterns of MI admissions post-lockdown remain under-investigated.
Purpose of the Study:
- To analyze the incidence rates (IRs) of acute MI admissions in Italy following the national COVID-19 lockdown.
- To compare MI admission rates during the post-lockdown period with pre-lockdown, intra-lockdown, and inter-year control periods.
Main Methods:
- Retrospective analysis of 2415 patients admitted for acute MI across nine Italian centers.
- Comparison of MI incidence rates (IRs) between the post-lockdown period (May 4-July 12, 2020) and control periods (pre-lockdown, intra-lockdown, inter-year non-COVID-19).
Main Results:
- MI admissions increased significantly post-lockdown compared to the intra-lockdown period (IRR: 1.60).
- Post-lockdown MI admissions were lower than pre-lockdown (IRR: 0.86) but similar to the previous year (IRR: 0.96).
- The increase in MI admissions was more pronounced in early post-lockdown weeks and significant for non-ST-segment elevation MI, but not for ST-segment elevation MI (STEMI), which saw reduced hospitalizations (IRR: 0.76).
Conclusions:
- This study is the first to report an increase in MI admissions after Italy's national COVID-19 lockdown.
- The rise in MI admissions was concentrated in the initial weeks post-lockdown.
- ST-segment elevation MI (STEMI) hospitalizations did not recover to pre-pandemic levels, suggesting persistent impacts of the pandemic on acute cardiac care.
Background:
Investigations demonstrated a decrease of admissions for myocardial infarction (MI) during the CoronaVirus Disease-19 (COVID-19) 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 post-lockdown 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.
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