key: cord-0702528-x14e5xbt
authors: Lapostolle, Frédéric; Nallet, Olivier; Vianu, Isabelle; Benamer, Hakim; Digne, Franck; Walylo, François; Adnet, Frédéric; Boccara, Albert
title: Impact of the COVID-19 Epidemic on the Incidence of Acute Myocardial Infarction in Seine-Saint-Denis
date: 2020-09-11
journal: nan
DOI: 10.1016/j.lpmope.2020.100002
sha: 077b3d44eeb500146403775f6c261aa6c4822011
doc_id: 702528
cord_uid: x14e5xbt

nan

J o u r n a l P r e -p r o o f 

It has been suggested in the media that the COVID-19 epidemic and its impact on hospitals is associated with a reduction in the number of patients admitted to the hospital with acute myocardial infarction or stroke.(1-3) An alternative hypothesis is that the considerable increase in general activity in all hospital departments may have led to a phenomenon of dilution of these pathologies among the many cases of COVID-19. Cardiology departments have not been spared this increase in activity due to the high number of cardiac complications due to COVID-19.(4) We studied the incidence of acute myocardial infarction during the COVID-19 epidemic in our department.

Seine-Saint-Denis is an urban area of approximately 1.6 million inhabitants. Its population is socioeconomically disadvantaged and has been heavily affected by the COVID-10 epidemic. There are five hospitals in Seine-Saint-Denis equipped to perform coronary angiography procedures 24 hours a day.

To evaluate the incidence of acute MI, we selected all patients presenting with ST-segment Elevation

Myocardial Infarction (STEMI) admitted to these five facilities.

The analysis period, March 2020, corresponds to the peak of the COVID-19 epidemic in our region. In period, 53 patients were admitted to the region's hospitals, representing a monthly incidence of 3.3 STEMI per 100,000 inhabitants. There was no significant difference between the two periods (p=0.8 -Chi 2 test).

One out of five facilities received more patients in 2020, and three out of five received fewer. The detailed numbers of admissions per establishment figure in the table below.

The incidence of STEMI patients admitted to our region's medical centers equipped to perform coronary angiography procedures 24 hours a day did not vary. However, patient transfers were affected by the regional reorganization efforts aimed at increasing overall hospitalization capacities as well as COVID-19 patient admissions into ICU. Therefore, the majority of these facilities did in fact see a decrease in the number of patients admitted. This was offset by one hospital that considerably increased its activity when activity decreased in other facilities. This can explain the impression of a global decrease in the number of acute myocardial infarctions, although it is not confirmed by data. Furthermore, we cannot exclude that the number of delayed admissions were increased. This was recently reported in a small study of seven Chinese patients, and merits further study.(5) However our aim was not to answer this question, but to evaluate claims of decreases in the number of patients presenting with myocardial infarction. Indeed, 'impressions' are not necessarily supported by the data as in the case of STEMI above and as we recently reported in patients with cardiac arrest in COVID-19 period.(6) These results will have to be confirmed on a larger scale and in other regions.

Incidence of acute myocardial infarction did not decrease during the COVID-19 epidemic in our region.

Redistribution of patients throughout our medical centers due to organizational changes in the face of the COVID-19 epidemic and the resulting patient load may have contributed to this sense of increase, although it is not supported by data. 

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