Van Belle Eric, Manigold Thibault, Piérache Adeline, Furber Alain, Debry Nicolas, Luycx-Bore Anne, Bauchart Jean-Jacques, Nugue Olivier, Huchet François, Bic Mathieu, Vinchon François, Sayah Smaïn, Fournier Alexandre, Decoulx Eric, Mouhammad Usman, Clerc Jérôme, Manchuelle Aurélie, Lazizi Tahar, Chmait Akram, Jeannetteau Julien, Hénon Pierre, Bonin Mickael, Dupret-Minet Marie, Tirouvanziam Ashok, Molcard David, Arabucki Fabien, Py Antoine, Prunier Fabrice, Delhaye Cédric, Lemesle Gilles, Schurtz Guillaume, Cosenza Alessandro, Spillemaeker Hugues, Verdier Basile, Denimal Tom, Pamart Thibault, Sylla Habib, Janah Dany, Aouate David, Porouchani Sina, Guillez Valérie, Bonnet Guillaume, Ternacle Julien, Labreuche Julien, Cayla Guillaume, Vincent Flavien
CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France.
CHU Nantes, Nantes, France.
Lancet Reg Health Eur. 2021 Mar;2:100030. doi: 10.1016/j.lanepe.2021.100030. Epub 2021 Jan 13.
A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided.
To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern "Hauts-de-France" province and western "Pays-de-la-Loire" Province. The incidence of COVID-19 fatalities was also collected.
In "Hauts-de-France", during lockdown (March 18-May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71-0.84, <0.001) was observed for a loss of 272 MIs (95%CI:-363,-181), representing 18% of COVID-19-related deaths. In "Pays-de-la-Loire", 382 COVID-19-related deaths were observed. A 19% decrease in MI-IR (IRR=0.81; 95%CI=0.73-0.90, <0.001) was observed for a loss of 138 MIs (95%CI:-210,-66), representing 36% of COVID-19-related deaths. While in "Hauts-de-France" the MI decline started before lockdown and recovered 3 weeks before its end, in "Pays-de-la-Loire", it started after lockdown and recovered only by its end. In-hospital mortality of MI patients was increased during lockdown in both provinces (5.0% vs 3.4%, =0.02).
It highlights one of the potential collateral damages of COVID-19 outbreak on cardiovascular health with a dramatic reduction of MI incidence. It advocates for a careful and weighted communication strategy in pandemic crises.
The study was conducted without external funding.
在大多数受新冠疫情影响的国家，心肌梗死（MI）入院人数有所减少。但尚未给出明确解释。
报告新冠疫情期间，特别是在法国两个受影响程度不同（1000万居民）且媒体策略不同的省份实施全国封锁期间心肌梗死（MI）的入院发生率，并描述MI发生率变化相对于新冠相关死亡发生率的幅度。在法国北部“上法兰西”省和西部“卢瓦尔河地区”省所有具备PCI设施的中心开展了一项纵向研究，收集2020年1月1日至5月17日（研究期）以及2019年同一时期（对照期）的所有心肌梗死病例。同时收集新冠死亡病例的发生率。
在“上法兰西”省，封锁期间（3月18日至5月10日），观察到1500例新冠相关死亡病例。心肌梗死发生率（MI-IR）下降了23%（发病率比值比IRR=0.77；95%置信区间CI：0.71 - 0.84，P<0.001），心肌梗死病例减少了272例（95%置信区间CI：-363，-181），占新冠相关死亡病例的18%。在“卢瓦尔河地区”省，观察到382例新冠相关死亡病例。心肌梗死发生率（MI-IR）下降了19%（IRR=0.81；95%置信区间CI=0.73 - 0.90，P<0.001），心肌梗死病例减少了138例（95%置信区间CI：-210，-66），占新冠相关死亡病例的36%。在“上法兰西”省，心肌梗死发生率下降始于封锁前，并在封锁结束前3周恢复；而在“卢瓦尔河地区”省，心肌梗死发生率下降始于封锁后，且仅在封锁结束时恢复。两个省份封锁期间心肌梗死患者的院内死亡率均有所上升（5.0%对3.4%，P=0.02）。
这凸显了新冠疫情对心血管健康的潜在附带损害之一，即心肌梗死发生率大幅下降。这提倡在疫情危机中采取谨慎且权衡的沟通策略。
本研究无外部资金支持。
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