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Multicenter Study
. 2021 Apr 15:329:251-259.
doi: 10.1016/j.ijcard.2020.12.059. Epub 2020 Dec 30.

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

Francesco Versaci  1 , Achille Gaspardone  2 , Alessandro Danesi  3 , Fabio Ferranti  4 , Massimo Mancone  5 , Enrica Mariano  6 , Francesco L Rotolo  7 , Carmine Musto  8 , Igino Proietti  9 , Andrea Berni  10 , Carlo Trani  11 , Sonia Cristina Sergi  12 , Giulio Speciale  13 , Gaetano Tanzilli  5 , Fabrizio Tomai  14 , Alessandro Di Giosa  15 , Giada Marchegiani  15 , Enrico Romagnoli  11 , Elena Cavarretta  16 , Roberto Carnevale  16 , Giacomo Frati  17 , Giuseppe Biondi-Zoccai  18
Affiliations
Multicenter Study

Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

Francesco Versaci et al. Int J Cardiol. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area.

Methods and results: Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001).

Conclusions: Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.

Keywords: Acute coronary syndrome; COVID-19; Climate; Environment; Pollution; Weather.

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Conflict of interest statement

Declaration of Competing Interest Prof. Biondi-Zoccai has consulted for Cardionovum, Bonn, Germany, InnovHeart, Milan, Italy, Meditrial, Rome, Italy, and Replycare, Rome, Italy.

Figures

Fig. 1
Fig. 1
Changes in the daily incidence of ST-elevation myocardial infarction (STEMI, top panel) and non-ST-elevation myocardial infarction (NSTEMI, bottom panel) in the first three months of 2019 and of 2020.
Fig. 2
Fig. 2
Association between mean daily nitric dioxide (NO2) concentration and risk of ST-elevation myocardial infarction (STEMI): black dots show the first 3 months of 2019, and blue dots the first 3 months of 2020, and dot size represents the number of same day coronavirus disease 2019 (COVID-19) deaths; the smooth line was computed using a generalized additive model. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Association between mean daily nitric dioxide (NO2) concentration and risk of ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI): black dots show the first 3 months of 2019, and blue dots the first 3 months of 2020, and dot size represents the number of same day coronavirus disease 2019 (COVID-19) tests; the smooth line was computed using a generalized additive model. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 4
Fig. 4
Association between mean daily nitric dioxide (NO2) concentration and risk of non-ST-elevation myocardial infarction (NSTEMI): black dots show the first 3 months of 2019, and blue dots the first 3 months of 2020, and dot size represents the number of same day coronavirus disease 2019 (COVID-19) cases; the smooth line was computed using a generalized additive model. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

Comment in

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