Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era
Authors: De Rosa Salvatore , Spaccarotella Carmen , Basso Cristina , Calabrò Maria Pia , Curcio Antonio , Filardi Pasquale Perrone , Mancone Massimo , Mercuro Giuseppe , Muscoli Saverio , Nodari Savina , Pedrinelli Roberto , Sinagra Gianfranco , Indolfi Ciro ,   Società Italiana di Cardiologia and the CCU Academy investigators group, Angelini Filippo , Barillà Francesco , Bartorelli Antonio , Benedetto Francesco , Bernabò Paola , Bolognese Leonardo , Briani Martina , Cacciavillani Luisa , Calabrese Alice , Calabrò Paolo , Caliendo Luigi , Calò Leonardo , Casella Gianni , Casu Gavino , Cavallini Claudio , Ciampi Quirino , Ciccone Marco , Comito Michele , Corrada Elena , Crea Filippo , D’Andrea Antonello , D’Urbano Maurizio , De Caterina Raffaele , De Ferrari Gaetano , De Ponti Roberto , Della Mattia Alessio , Di Mario Carlo , Donazzan Luca , Esposito Giovanni , Fedele Francesco , Ferraro Alessandro , Galasso Gennaro , Galiè Nazzareno , Gnecchi Massimiliano , Golino Paolo , Golia Bruno , Guarini Pasquale , Indolfi Ciro , Leonardi Sergio , Locuratolo Nicola , Luzza Francesco , Manganiello Vincenzo , Francesca Marchetti Maria , Marenzi Giancarlo , Margonato Alberto , Meloni Luigi , Metra Marco , Milo Marco , Mongiardo Annalisa , Monzo Luca , Morisco Carmine , Nodari Savina , Novo Giuseppina , Pancaldi Stefano , Parollo Matteo , Paternò Giovanni , Patti Giuseppe , Priori Silvia , Ravera Amelia , Giuseppe Rebuzzi Antonio , Rossi Massimo , Scherillo Marino , Semprini Franco , Senni Michele , Sibilio Gerolamo , Sinagra Gianfranco , Siviglia Massimo , Tamburino Corrado , Tortorici Gianfranco , Versace Francesco , Villari Bruno , Volpe Massimo 
Published: April 2020

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 &lt; 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 &lt; 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 &lt; 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.