key: cord-0969996-zf4f730n
authors: Fardman, Alexander; Oren, Daniel; Berkovitch, Anat; Segev, Amit; Levy, Yuval; Beigel, Roy; Matetzky, Shlomi
title: Post Covid-19 acute myocardial infarction rebound
date: 2020-08-28
journal: Can J Cardiol
DOI: 10.1016/j.cjca.2020.08.016
sha: d40c05081d2753134777f8307c82ff900ebe2881
doc_id: 969996
cord_uid: zf4f730n

nan

As the first wave of Covid-19 came to a relative trough during May 2020 in parts of Europe and 1 some states in the US, for example Vermont, New York and New Jersey, we are now beginning 2 to observe a resurgence in acute myocardial infarction (AMI) admissions in Israel [1] . 3 We collected data from consecutive patients presenting with AMI who were hospitalized in the 4

Intensive Coronary Care Unit (ICCU) of a single tertiary Medical Center in Israel during a 10-5

week period from March 8 th through May 16 th , 2020. Social distancing restrictions were 6 announced in Israel on March 11 th , 2020. We compared the mean daily AMI hospitalization rates 7 during this period and the corresponding periods during 2017-2019. The incidence of newly, 8 confirmed coronavirus cases in Israel was based on the Ministry of Health records. 9

Our study comprised 440 consecutive patients, of whom 107 (24%) were hospitalized during the 10 Covid-19 outbreak. Median age was 66 years (interquartile range 56-75 years), 341 (78%) were 11 male and 241 (55%) were diagnosed with ST-elevation MI (STEMI). In agreement with previous 12 studies [2-3], we observed a 12%, 20% and 18% reduction in the AMI daily admission rates 13 during 3 bi-weekly periods at the early phase of the coronavirus outbreak (March 8 th -March 14 21 st , March 22 nd -April 4 th , and April 5 th April 18 th respectively), compared with the mean 15 hospitalization incidence during the corresponding periods in 2017-2019. In contrast, we 16 observed a 9% and 26% increase in AMI admissions during 2 bi-weekly periods at the late phase 17 (April 19 th -May 2 nd , May 3 rd -May 16 th ,2020). The trend in AMI hospitalizations inversely 18 correlated with the rise and fall in the incidence of newly diagnosed coronavirus cases during the 19 parallel time periods ( Figure 1A ). As shown in Figure 1B , there was a substantial difference in 20 the trends of Non-ST-segment myocardial infarction (NSTEMI) and STEMI admissions. While 21 the observed reduction in AMI admissions during the early phase derived mainly from a 22 reduction in NSTEMI then STEMI patients, the rebound increase in AMI admissions during the 23 late phase reflected by a remarkable increase in the STEMI rates (16% and 100% elevation 1 respectively. The rebound increase in hospitalizations during the late phase of the Covid-19 2 outbreak was characterized by a significantly higher proportion of males compared with the 3 corresponding period in 2017-2019 (88% vs 70%, p value =0.01), and numerical higher 4 compared with the early phase of the Covid-19 outbreak (88% vs 77%, p value =0.12). The 5

proportion of older patients (>65 years) was numerical higher compared with both previous years 6 (67% vs 52%, p value=0.07) and the early phase of the Covid-19 pandemic (67% vs 52%, p 7 value =0.12). We observed no difference in other baseline characteristics. 8

This is the first report to describe a worrisome increase in STEMI hospitalization 9

correlating with the fading of the first wave of the Covid-19 pandemic. In contrast, the trend of 10 the reduction in NSTEMI hospitalization rates, also milder in its extent, continued during the 11 decline in the Covid-19 cases. While the explication of underlying mechanisms for these trends 12 is beyond the scope of this report, the surge in the incidence of AMI following national disasters 13 has been previously described [4] . Regarding the different trend in NSTEMI admissions, we 14 could hypothesize that NSTEMI patients' manifest less severe symptoms that STEMI and might 15 be able to tolerate them for a longer time and might opt, therefore, to remain at home even during 16 a reduction in Covid-19 cases. We of course cannot rule out that the differences between 17 NSTEMI and STEMI represent deferential biologic effects of strenuous triggers on the 18 occurrence of NSTEMI and STEMI. 19

Despite the limitations of this single center observational study, the post-Covid-19 rebound effect 20 should be addressed as a unique phenomenon that should be further investigated. We urge 21 healthcare policy makers and critical care providers to be mindful of the potential for AMI 22 J o u r n a l P r e -p r o o f

Reduced Rate of Hospital Admissions for

ACS during Covid-19 Outbreak in Northern Italy

Acknowledgments: none.