Cardiovascular Department.
Biostatistics Unit, Department of Medical Sciences.
J Cardiovasc Med (Hagerstown). 2021 May 1;22(5):344-349. doi: 10.2459/JCM.0000000000001153.
Public health emergencies such as the COVID-19 outbreak may impact on the incidence rate of ST-elevation myocardial infarction (STEMI) in severely affected areas. However, this phenomenon demands attention also in areas where media and patients were focused on the COVID-19 pandemic, but the healthcare system was not overwhelmed by the huge number of COVID-19 patients.
In this observational study, we compared the incidence rate of all consecutive STEMI patients admitted at the University Hospital of Trieste, Italy, during March and April 2020 with the same 2 months of the previous 5 years (2015-2019). Patient characteristics were compared between 2020 and 2019.The incidence rate of STEMI admission in March-April 2020 was lower than those in March-April 2015-2019, 36 vs. 56 cases per 100 000 inhabitants/year [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.42-0.96, P = 0.045]. Considering that the incidence rates were constant in the past years (P = 0.24), the turnaround in 2020 is most likely due to the COVID-19 outbreak. Interestingly, this reduction was a dynamic phenomenon with a U-shaped curve during the 2-month period. System-of-care times were similar between 2020 and 2019; however in 2020, patients presented more frequently signs of heart failure compared to 2019 (Killip class ≥2 in 68% vs. 29%, P = 0.003).
During the COVID-19 outbreak, we observed a marked reduction in the STEMI incidence rate. This U-shaped phenomenon demands attention because a potential cause for the decrease in STEMI incidence may include the avoidance of medical care. Public campaigns aiming to increase awareness of ischemic symptoms may be needed during community outbreak.
COVID-19 等公共卫生紧急情况可能会影响受严重影响地区的 ST 段抬高型心肌梗死（STEMI）的发病率。然而，在媒体和患者关注 COVID-19 大流行但医疗系统并未因大量 COVID-19 患者而不堪重负的地区，这种现象也值得关注。
在这项观察性研究中，我们比较了意大利的的里雅斯特大学医院 2020 年 3 月和 4 月连续收治的所有 STEMI 患者的发病率与前 5 年（2015-2019 年）同期相同的 2 个月。比较了 2020 年和 2019 年的患者特征。2020 年 3 月至 4 月 STEMI 入院率低于 2015-2019 年同期，每 100000 居民/年 36 例与 56 例（相对风险（RR）0.65，95%置信区间（95%CI）0.42-0.96，P=0.045）。考虑到过去几年发病率保持不变（P=0.24），2020 年的逆转很可能是由于 COVID-19 爆发。有趣的是，这种减少是一个动态现象，在 2 个月期间呈 U 形曲线。2020 年和 2019 年的医疗服务时间相似；然而，2020 年患者出现心力衰竭迹象的频率高于 2019 年（Killip 分级≥2 占 68% vs. 29%，P=0.003）。
在 COVID-19 爆发期间，我们观察到 STEMI 发病率的显著下降。这种 U 形现象值得关注，因为 STEMI 发病率下降的潜在原因可能包括避免医疗保健。在社区爆发期间，可能需要开展旨在提高对缺血症状认识的公众宣传活动。
