Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era
Salvatore De Rosa, Carmen Spaccarotella, Cristina Basso, Maria Pia Calabrò, Antonio Curcio, Pasquale Perrone Filardi, Massimo Mancone, Giuseppe Mercuro, Saverio Muscoli, Savina Nodari, Roberto Pedrinelli, Gianfranco Sinagra, Ciro Indolfi, Filippo Angelini, Francesco Barillà, Antonio L. Bartorelli, Francesco Benedetto, Paola Bernabò, Leonardo Bolognese, Martina Briani, Luisa Cacciavillani, Alice Calabrese, Paolo Calabrò, Luigi Caliendo, Leonardo Calò, Gianni Casella, Gavino Casu, Claudio Cavallini, Quirino Ciampi, Marco Matteo Ciccone, Michele Comito, Elena Corrada, Filippo Crea, Antonello D’Andrea, Maurizio DʼUrbano, Raffaele De Caterina, Gaetano Maria De Ferrari, Roberto De Ponti, Alessio Della Mattia, Carlo Di Mario, Luca Donazzan, Giovanni Esposito, Francesco Fedele, Alessandro Ferraro, Gennaro Galasso, Nazzareno Galiè, Massimiliano Gnecchi, Paolo Golino, Bruno Golia, Pasquale Guarini, Ciro Indolfi, Sergio Leonardi, Nicola Locuratolo, Francesco Luzza, Vincenzo Manganiello, Maria Francesca Marchetti, Giancarlo Marenzi, Alberto Margonato, Luigi Meloni, Marco Metra, Marco Milo, Annalisa Mongiardo, Luca Monzo, Carmine Morisco, Savina Nodari, Giuseppina Novo, Stefano Pancaldi, M Parollo, Giovanni Paternò, Giuseppe Patti, Silvia G. Priori, Amelia Ravera, Antonio G. Rebuzzi, Massimo Rossi, Marino Scherillo, Franco Semprini, Michele Senni, Gerolamo Sibilio, Gianfranco Sinagra, Massimo Siviglia, Corrado Tamburino, Gianfranco Tortorici, Francesco Versace, Bruno Villari, Massimo Volpe
Abstract
AIMS: To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs). METHODS AND RESULTS: We conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7-32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3-70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7-6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1-2.8; P = 0.009). CONCLUSION: Admissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies.