key: cord-0752353-uzkimiga
authors: Čulić, Viktor; AlTurki, Ahmed; Proietti, Riccardo
title: Letter to the Editor Regarding: Acute Coronary Syndrome in the COVID-19 Pandemic: Reduced Cases and Increased Ischaemic Time by Sutherland et al. Heart Lung Circ. 2022;31(1):69-76
date: 2022-01-11
journal: Heart Lung Circ
DOI: 10.1016/j.hlc.2021.11.008
sha: 9b2864bac45dfff18c7b66b7c9fe3ef7442380eb
doc_id: 752353
cord_uid: uzkimiga

nan

Heart, Lung and Circulation (2021) -, --- To the Editor, Sutherland and colleagues recently reported a reduction in patients admitted with acute coronary syndrome (ACS) and an increase in total ischaemic time during the first and second wave of the COVID-19 outbreak in Melbourne [1] . They also observed a 20% rebound increase in ACS presentations following the relaxation of public health restrictions in November-December 2020 compared to the same period of 2019 and suggested that this could represent long-term sequelae of untreated ACS including reinfarction and heart failure. However, several additional mechanisms could play a role.

A trend of reduced hospitalisations for all ACS types during the pandemic has been observed worldwide [1] [2] [3] . Besides social distancing, stay-at-home orders, and fear of acquiring the infection, attenuated exposure to well-recognised ACS triggers, particularly reduced air pollution, and decreased physical and work activities, has been linked to this phenomenon [3, 4] . The alleviation of restrictions after the pandemic waves restored the level of exposure to ACS triggers which could have contributed to a gradual increase in ACS hospitalisations [4] . Moreover, fear of lack of medical care, lockdown stress, anger, loneliness, job loss, financial stress, and binge smoking have been suggested as ACS triggers due to the ramification of the pandemic [5] . Along this line, a postrestriction increase in hospitalisations for ST-segment elevation myocardial infarction has been documented in Israel [2] .

Anti-pandemic measures favour sedentary behaviour, physical inactivity, unhealthy nutritional habits, weight gain, and increased alcohol consumption, as confirmed by recent meta-analyses [6, 7] . Consequent negative effects on metabolism likely worsened the population's cardiovascular health and, given their presence for over a year now, could have increased the number of vulnerable coronary patients [4] . Accordingly, increased population cardiovascular vulnerability coupled with enhanced exposure to ACS triggers could be important mechanisms of a rebound increase in ACS.

Acute coronary syndrome in the COVID-19 pandemic: reduced cases and increased ischaemic time

Post Covid-19 acute myocardial infarction rebound

Ó 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

Pandemic: Reduced Cases and Increased Ischaemic Time by Sutherland et al. Heart Lung Circ

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Covid-19 pandemic and possible rebound phenomenon in incidence of acute myocardial infarction

The Covid-19 pandemic and triggered acute myocardial infarction among non-infected individuals

Impact of the first COVID-19 lockdown on body weight: a combined systematic review and a meta-analysis

The impact of COVID-19 lockdown on snacking habits, fast-food and alcohol consumption: a systematic review of the evidence

Pandemic: Reduced Cases and Increased Ischaemic Time by Sutherland et al. Heart Lung Circ