Key result
The COVID-19 lockdown was associated with decreased AMI admissions, increased 30-day NSTEMI mortality (7.5% vs 5.4%; OR 1.41), and decreased 30-day STEMI mortality (7.7% vs 10.2%; OR 0.73).
Why the study?
It was unknown whether the COVID-19 pandemic altered patient response, hospital treatment, and mortality for hospitalized acute myocardial infarction.
Does the COVID-19 pandemic lockdown affect patient response, hospital treatment, and mortality in patients with acute myocardial infarction?
Observational
Yes
Does the COVID-19 pandemic lockdown affect patient response, hospital treatment, and mortality in patients with acute myocardial infarction?
Odds Ratio: 1.41 (95% CI 1.08–1.8)
Absolute Event Rate: 7.5% vs 5.4%
The COVID-19 pandemic lockdown in England was associated with a significant decline in AMI admissions, with presenting patients being younger and less comorbid, alongside increased 30-day mortality for NSTEMI and decreased for STEMI.
Reduced AMI admissions and NSTEMI management shifts during early COVID-19 may signal care delays; leaves open whether mortality patterns persist post-pandemic.
AIMS: COVID-19 might have affected the care and outcomes of hospitalized acute myocardial infarction (AMI). We aimed to determine whether the COVID-19 pandemic changed patient response, hospital treatment, and mortality from AMI. METHODS AND RESULTS: Admission was classified as non-ST-elevation myocardial infarction (NSTEMI) or STEMI at 99 hospitals in England through live feeding from the Myocardial Ischaemia National Audit Project between 1 January 2019 and 22 May 2020. Time series plots were estimated using a 7-day simple moving average, adjusted for seasonality. From 23 March 2020 (UK lockdown), median daily hospitalizations decreased more for NSTEMI [69 to 35; incidence risk ratios (IRR) 0.51, 95% confidence interval (CI) 0.47-0.54] than STEMI (35 to 25; IRR 0.74, 95% CI 0.69-0.80) to a nadir on 19 April 2020. During lockdown, patients were younger (mean age 68.7 vs. 66.9 years), less frequently diabetic (24.6% vs. 28.1%), or had cerebrovascular disease (7.0% vs. 8.6%). ST-elevation myocardial infarction more frequently received primary percutaneous coronary intervention (81.8% vs. 78.8%), thrombolysis was negligible (0.5% vs. 0.3%), median admission-to-coronary angiography duration for NSTEMI decreased (26.2 vs. 64.0 h), median duration of hospitalization decreased (4 to 2 days), secondary prevention pharmacotherapy prescription remained unchanged (each > 94.7%). Mortality at 30 days increased for NSTEMI [from 5.4% to 7.5%; odds ratio (OR) 1.41, 95% CI 1.08-1.80], but decreased for STEMI (from 10.2% to 7.7%; OR 0.73, 95% CI 0.54-0.97). CONCLUSION: During COVID-19, there was a substantial decline in admissions with AMI. Those who presented to hospital were younger, less comorbid and, for NSTEMI, had higher 30-day mortality.
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Wu et al. (2020) conducted an observational in Acute myocardial infarction (NSTEMI and STEMI). COVID-19 pandemic lockdown vs. Pre-lockdown period was evaluated on 30-day mortality for NSTEMI (OR 1.41, 95% CI 1.08-1.80). The COVID-19 lockdown was associated with decreased AMI admissions, increased 30-day NSTEMI mortality (7.5% vs 5.4%; OR 1.41), and decreased 30-day STEMI mortality (7.7% vs 10.2%; OR 0.73).
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