“Missing” acute coronary syndrome hospitalizations during the COVID‐19 era in Greece: Medical care avoidance combined with a true reduction in incidence?

FIGURE 1. Number of acute coronary syndrome (ACS)‐related hospitalizations during the COVID‐19 outbreak (6‐weeks: 2 March 2020 to 12 April 2020 [orange bars]) are significantly reduced compared with the corresponding control period in 2019 (blue bars) overall and separately for ST‐segment elevation myocardial infarction (STEMI), non‐STEMI (NSTEMI) and unstable angina (UA). P values are derived from Poisson regression analysis

FIGURE 2. A, The overall number of admissions for acute coronary syndromes (ACS) on a week‐per‐week basis showed a gradual decline during the COVID‐19 period. B, The incidence rate ratio of admissions (ie, relative change in COVID‐19 compared with the control period) per week assessed separately for ST‐segment elevation myocardial infarction (STEMI) and non‐STEMI/unstable angina (UA) showed a temporal trend for NSTEMI/UA (P = .026) but not for STEMI (P = .53) which remained stable throughout the study period. Best‐fit curves (logarithmic) with the coefficients of determination (R2) are demonstrated

FIGURE 3. Cumulative number of acute coronary syndrome (ACS) hospitalizations plotted over the 42 days (6‐weeks) during the COVID‐19 outbreak (2 March 2020 to 12 April 2020 [orange]) and the corresponding period in 2019 (blue). The corresponding trend lines by linear regression are also shown. The numbers started to diverge substantially between March 16th (lockdown for over 80% of business type activities; yellow vertical line) and March 23rd (complete national lockdown with restriction of freedom of movement; red vertical line). There was an overall significant difference in the slopes of the regression lines between the COVID‐19 and control periods (17.3 vs 25.7 admissions/day, respectively; ratio of slopes: 0.68, 95% CI: 0.66‐0.70, P < .001)