Hospital Admissions for Acute Myocardial Infarction Before and After Lockdown According to Regional Prevalence of COVID-19 and Patient Profile

Abstract

Aim: to evaluate the impact of a nationwide lockdown in France on acute myocardial infarction (AMI) admissions, by patient characteristics and regional prevalence of the pandemic.

Methods and Results: We collected data from 21 centres participating in the on-going FRENCHIE registry (NCT04050956), which collects data from all patients admitted for STEMI or NSTEMI within 48 hours of symptom onset. We compared weekly admissions in the 4 weeks preceding and the 4 weeks following institution of the lockdown. We observed a brutal 30% decrease in AMI admissions (24% for STEMI and 36% for NSTEMI, P=0.14) following institution of the lockdown, with similar trends according to gender (30% decrease in both men and women), risk factors, and regional prevalence of COVID-19. The decrease was numerically greater in patients aged 80 years or more (44% vs 27%, P=0.10). Patient characteristics, including time to hospital admission in STEMI patients, did not differ between the 2 periods. In-hospital mortality was numerically higher following institution of the lockdown (5.2% vs 3.4%, P=0.12), with similar trends for STEMI and NSTEMI.

Conclusion: A marked decrease in hospital admissions was observed following the lockdown, irrespective of patient characteristics and regional prevalence of COVID-19. Health authorities should be aware of these findings, in order to adapt their message in case of a second wave of the pandemic or future major epidemics.

Funding Statement: The FRENCHIE registry is supported by Recherche Hospitalo-universitaire en santé (RHU) iVasc within the programme "Investissements d'avenir", and sponsored by Assistance Publique – Hôpitaux de Paris (Délégation à la Recherche Clinique et à l'Innovation).

Declaration of Interests: YC reports research Grants to the Institution or Consulting/Lecture Fees from : Novartis , Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, outside the submitted work. P. Coste reports having received fees from Amgen, AstraZeneca, Bayer and Servier, outside the submitted work G. Lemesle reports personal fees from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BristolMyers Squibb, MSD, Novartis, Pfizer, Sanofi-Aventis, Servier, and The Medicine Co, outside the submitted work. FS reports personal fees from Amgen, Astra Zeneca, Bayer, BMS, MSD, Pfizer, and Sanofi, outside the submitted work D. Angoulvant reports receiving consulting and lecture fees from AstraZeneca, Bayer, Bristol-Myers Squibb/Pfizer, Sanofi, Amgen, Novartis, Novo-Nordisk, Servier and MSD, outside the submitted work C. Bouleti reports receiving consulting and lecture fees from Novartis and AstraZeneca, outside the submitted work. G. Cayla has received research grants/consultant fees/lectures fees from Amgen, AstraZeneca, Abbott, Bayer, Biotronik, Bristol-Myers Squibb, Pfizer, Sanofi-Aventis, outside the submitted work. P. Goube reports receiving consulting and lecture fees from AMGEN, SANOFI, BMS, ABBOT, outside the submitted work. T. Lhermusier has received research grants/consultant fees/lectures fees from AstraZeneca, Boston scientifics and Abbott, outside the submitted work A. Saib reports lectures fees from Novartis, outside the submitted work JG Dillinger reports receiving consulting and lecture fees from AstraZeneca, Bayer, BoehringerIngelheim, Bristol-Myers Squibb/Pfizer, Sanofi, and Daiichi-Sankyo and grants from Bayer, BristolMyers Squibb/Pfizer and Biosensors, outside the submitted work. F. Boccara reports research grants from Amgen; lecture fees from Janssen, Gilead, ViiV Healthcare, Amgen, Sanofi, MSD, and Servier outside the submitted work. And personal consultant or lecture fees from Amgen, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Intercept, MSD, Novartis, Pfizer, Sanofi, and Servier, outside the submitted work. T. Simon reports grants from Astrazeneca, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Sanofi, and personal fees for board membership and/or consultancy and/or lectures from AstraZeneca, BMS, Sanofi, and Novartis, outside the submitted work. N. Danchin has received research grants, or speaking and consulting fees from Amgen, AstraZeneca, BMS, Boehringer Ingelheim, Eli-Lilly, Intercept, MSD, Novartis, Novo-Nordisk, Pfizer, Sanofi, Servier, outside the submitted work. The other authors have nothing to report.

Ethics Approval Statement: FRENCHIE has been approved by the Comité de Protection des Personnes and by the French data regulatory authority (Commission Nationale de l'Informatique et des Libertés).

Keywords: COVID-19; Acute myocardial infarction; epidemiology; trends