ABSTRACT
Background During SARS-CoV-2 pandemic, various studies have shown a significant reduction of Emergency Department (ED) presentations for acute cardiac diseases requiring in-hospital management. The aim of our study was to quantify hospital admission and mortality, comparing pandemic period and pre-pandemic period in different countries. Methods We performed an updated meta-analysis of observational studies to quantify on a large basis the impact of the SARS-CoV-2 outbreak on patients admitted to the ED for STEMI and NSTEMI. The literature research was conducted on PubMed, EMBASE, Scopus, Science Direct, Web of Science and Cochrane database registry on 6 January 2022. We performed a random-effect model meta-analysis. Results A total of 61 studies were included: came from Italy, China, Germany, Israel, Turkey, France, Helvetic Confederation, India, Poland, Spain, US, UK, Albania, Austria, Egypt, Greece, Iran, Ireland, Japan, Pakistan, Portugal, Saudi Arabia and Canada. Hospital admissions for STEMI decreased in most country. The countries with the high levels of reduction were Italy (IRR = 0.68) and Germany (IRR = 0.69). Mortality rates for STEMI increased differently among countries analyzed: p = 0.003. The highest mortality rate was in Serbia (OR = 2.15), followed by Italy (OR = 1.97), Pakistan (OR = 1.69) and France (OR = 1.55). Among the High-Income countries, the highest mortality rate was in Italy (OR = 3.71), the highest among the Upper-Middle-Income was in Serbia (OR = 2.15) and the highest among Low- Middle-Income was in Pakistan (OR = 1.69). Regarding NSTEMI, hospital admissions showed that Italy had the lowest value for with IRR = 0.59. Among countries, the meta-regression subgroups analysis, showed statistical difference (p < 0.001). Conclusions Our meta-analysis may represent a robust snapshot that might help healthcare systems manage and assist an expected higher number of people coming to the hospitals for severe, post-acute cardiological issues in the future. Key messages • The study shows hospital admission and mortality, comparing pandemic period and pre-pandemic period in different countries. • Epidemiological data suggests that one-fourth to one-third of MI patients, in large areas of the globe, during the COVID-19 pandemic in 2020, remained at home and did not have access to ED.
ABSTRACT
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.
ABSTRACT
INTRODUCTION: The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. METHODS: Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1-February 19, 2020) and previous-year control periods (February 20-May 3, 2019). ACS patients with Covid-19 were further compared with those without. RESULTS: Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively;p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%;p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. CONCLUSION: ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.