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. 2025 Jun 6:12:1540783.
doi: 10.3389/fcvm.2025.1540783. eCollection 2025.

Observed and expected overall mortality for acute myocardial infarction during the COVID-19 pandemic in Italy: an analysis of nationwide institutional databases

Leonardo De Luca #  1 , Francesco Grippo #  2 , Paola D'Errigo  3 , Alessandra Burgio  2 , Stefano Rosato  3 , Barbara Giordani  4 , Giorgia Duranti  4 , Giovanni Baglio  4
Affiliations

Observed and expected overall mortality for acute myocardial infarction during the COVID-19 pandemic in Italy: an analysis of nationwide institutional databases

Leonardo De Luca et al. Front Cardiovasc Med. .

Abstract

Aim: To carry out a nationwide evaluation of both in- and out-of-hospital mortality for acute myocardial infarction (AMI) during the COVID-19 pandemic period in Italy.

Methods: This was a retrospective cohort study analysing overall mortality for AMI in Italy during the COVID-19 pandemic (March 1st, 2020-December 31st, 2021) and the previous 5 years (January 1st, 2015-February 29th, 2020). To carefully analyze both in- and out-of-hospital mortality for AMI (with or without concomitant COVID-19 infection) we used different institutional administrative sources of national data. Excess mortality related to AMI during the COVID-19 pandemic has been analyzed using the observed/expected ratio (OER).

Results: Over the 5 years pre-pandemic period, 150,299 fatal events related to AMI occurred. During the pandemic, the number of deaths related to AMI was 28,673 in 2020 and declined to 26,688 in 2021. The overall OER was 1.18 [95% confidence intervals (CI): 1.15-1.22] in 2020 and 1.19 (95% CI: 1.15-1.22) while out-of-hospital OER was 1.24 (95% CI: 1.20-1.29) in 2020 and 1.21 (95% CI: 1.16-1.25) during the pandemic. When excluding COVID-19 related deaths, the number of observed in-hospital deaths did not significantly differ from the expected both in 2020 and 2021 while the excess remains unchanged for out-of-hospital mortality.

Conclusions: In this analysis of nationwide institutional administrative databases, we documented an increase in observed mortality compared to the expected during the COVID-19 pandemic in Italy. This mortality increase is mainly attributable to out-of-hospital fatal events and related to concomitant COVID-19 infection for hospitalized AMI patients.

Keywords: COVID-19 infection; acute myocardial infarction; administrative database; cohort study; mortality.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Number of hospitalizations for AMI in Italy before (2015–2019) and during COVID-19 pandemic (2020–2021). (A) Overall; (B) STEMI; (C) NSTEMI.
Figure 2
Figure 2
Observed and expected (based on Poisson model) deaths related to acute myocardial infarction by month and observed/expected ratio by year. (A) Overall; (B) in-hospital deaths; (C) out-of-hospital deaths.
Figure 3
Figure 3
Observed and expected (based on Poisson model) in hospital deaths related to AMI by month and observed/expected ratio by year, excluding deaths with concomitant COVID-19.
See this image and copyright information in PMC

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