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. 2021 Mar:2:100030.
doi: 10.1016/j.lanepe.2021.100030. Epub 2021 Jan 13.

Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Eric Van Belle  1 , Thibault Manigold  2 , Adeline Piérache  3 , Alain Furber  4 , Nicolas Debry  5 , Anne Luycx-Bore  6 , Jean-Jacques Bauchart  7 , Olivier Nugue  8 , François Huchet  9 , Mathieu Bic  10 , François Vinchon  11 , Smaïn Sayah  12 , Alexandre Fournier  13 , Eric Decoulx  14 , Usman Mouhammad  15 , Jérôme Clerc  16 , Aurélie Manchuelle  17 , Tahar Lazizi  18 , Akram Chmait  19 , Julien Jeannetteau  20 , Pierre Hénon  21 , Mickael Bonin  2 , Marie Dupret-Minet  22 , Ashok Tirouvanziam  23 , David Molcard  24 , Fabien Arabucki  25 , Antoine Py  26 , Fabrice Prunier  4 , Cédric Delhaye  1 , Gilles Lemesle  1 , Guillaume Schurtz  1 , Alessandro Cosenza  1 , Hugues Spillemaeker  1 , Basile Verdier  1 , Tom Denimal  1 , Thibault Pamart  1 , Habib Sylla  1 , Dany Janah  1 , David Aouate  1 , Sina Porouchani  1 , Valérie Guillez  1 , Guillaume Bonnet  27 , Julien Ternacle  27 , Julien Labreuche  3 , Guillaume Cayla  28 , Flavien Vincent  1
Affiliations

Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Eric Van Belle et al. Lancet Reg Health Eur. 2021 Mar.

Abstract

Background: A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided.

Methods: 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.

Findings: 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, p<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, p<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%, p=0.02).

Interpretation: 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.

Funding: The study was conducted without external funding.

Keywords: COVID-19 outbreak; COVID-19, Coronavirus disease 2019; Clinical outcome; MI, Myocardial Infarction; Mortality; Myocardial Infarction; NSTEMI, non ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.

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Conflict of interest statement

Dr. Lemesle reports personal fees from Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Lilly, MSD, Mylan, Novartis, Novonordisk, Pfizer, Sanofi Aventis, Servier, outside the submitted work. Dr Delhaye reports personal fees from Medtronic outside the submitted work. Dr. Cayla reports personal fees from Amgen, personal fees from Astra Zeneca, personal fees from Bayer, personal fees from Biotronik, personal fees from Bristol Myers Squibb, grants and personal fees from Medtronic, personal fees from MSD, personal fees from Pfizer, personal fees from Sanofi, outside the submitted work. The other authors do not report any conflict of interest.

Figures

Fig 1
Fig. 1
Myocardial infarction incidence rate ratio, COVID-19-related death toll and cumulative number of Myocardial Infarction missing compared to same period in 2019. A): Haut-de-France province B): Pays-de-Loire province. COVID-19: coronavirus disease 2019; n=number.
See this image and copyright information in PMC

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