Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

As visits for AMI drop during pandemic, deaths rise

Key clinical point: While hospitalizations for acute MI declined sharply during the COVID-19 pandemic, deaths increased.

Major finding: Mortality for ST-segment elevation MI cases more than tripled to 14% during the outbreak, compared with 4% in 2019 (P < .001), and complication rates increased by 80% to 19% (P = .025).

Study details: A multicenter, observational, nationwide survey of 319 admissions for acute MI at Italian cardiac care units for March 12-19 during the COVID-19 outbreak with an equivalent week in 2019.

Disclosures: Salvatore De Rosa, MD, PhD, and colleagues have no relevant financial relationships to disclose.

Commentary

Recent reports have demonstrated a global decline in ST-segment elevation myocardial infarctions (STEMI) and primary percutaneous coronary intervention (PPCI) volumes in regions affected by the Covid-19 pandemic.1-3 This multicenter, observational study demonstrates a 48.4% reduction in admissions during the Covid-19 outbreak in Italy. The reduction was significant for both STEMI [26.5%, 95% CI: 21.7–32.3; p=0.009] and non-STEMI (65.1%, 95% CI: 60.3–70.3; p<0.001). The STEMI case fatality rate during the pandemic was substantially increased to 13.7% compared with the 4.1% registered in 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. Similarly, the NSTEMI case fatality rate was increased to 3.3% during the pandemic, compared with 1.7% in 2019 (RR = 1.9, 95% CI 0.5–6.7; P = 0.309). Major complications were almost doubled during the pandemic (10.7% in 2020 vs. 5.1% in 2019 (RR =2.1, 95% CI 1.05–4.1; P = 0.037).

The study was limited to only 2 weeks due to limited resources during the pandemic for data collection, but the findings highlight similar reports of 38% reduction in STEMI activations in US2 and ~40% reduction in PPCI in Spain.3 Causes of dramatic reduction in global STEMI volumes during the Covid-19 pandemic are likely multifactorial, including relocation of medical resources to manage the pandemic as well as public fear of becoming infected with Covid-19 virus which may lead to avoidance in seeking medical care. This study emphasizes the importance of timely adoption of countermeasures to avoid a large and long-standing impact from the Covid-19 pandemic.”

Luke Kim, MD

Weill Cornell Medical College/New York Presbyterian Hospital

References:
  1. Tam CF, Cheung KS, Lam S, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020 Mar 17. https://doi.org/10.1161/CIRCOUTCOMES.120.006631.
  2. Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-Segment Elevation Cardiac Catheterization Laboratory Activations in the United States during COVID-19 Pandemic. J Am Coll Cardiol. 2020 Apr 9. https://doi.org/10.1016/j.jacc.2020.04.011.
  3. Rodríguez-Leor O, Cid-Alvarez B, Ojeda S, et al. Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología ntervencionista en España. REC Interv Cardiol. 2020 Feb 4. https://doi.org/10.24875/RECIC.M20000120.

Citation:

De Rosa S et al. Euro Heart J. 2020 May 15. doi: 10.1093/eurheartj/ehaa409.