"Missing" acute coronary syndrome hospitalizations during theCOVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence?
"Missing" acute coronary syndrome hospitalizations during theCOVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence?
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DOI：
10.1002/clc.23424
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发表时间：
2020-07-21
影响因子：
2.7
通讯作者：
Michalis, Lampros K.
中科院分区：
文献类型：
--
作者：
Papafaklis, Michail I.;Katsouras, Christos S.;Michalis, Lampros K.
来自受COVID-19疫情严重打击的国家的报告显示，急性冠状动脉综合征（ACS）相关住院率下降。在COVID-19发病率较低的国家，这一观察结果对ACS入院的普遍性和可能的相关原因尚不清楚。假设在一个没有受到COVID-19影响的国家，ACS的入院人数减少了。方法我们在希腊进行了一项全国范围的研究，研究对象是2019年COVID-19爆发6周期间和相应控制期间的ACS相关入院发病率，希腊是一个社会措施严格、COVID-19发病率低、死亡率不高的国家。结果与对照组相比，COVID-19患者（n = 771）的ACS入院率（n = 1077）周期总体缩短（发病率比[IRR]：0.72，P <0.001）和每种ACS类型（ST段抬高型心肌梗死[STEMI]：IRR：0.76，P = .001;非STEMI：IRR：0.74，P < .001;不稳定型心绞痛[UA]：IRR：0.63，P = .002）。在整个COVID-19期间，STEMI入院率的下降保持稳定（时间相关性; R-2= 0.11，P = 0.53），而在逐步严格的社会措施之后，非STEMI/UA入院率逐渐下降（R-2= 0.75，P = 0.026）。在COVID-19期间，ACS患者更频繁地出现左心室收缩功能障碍（22.2% vs 15.5%对照期;P <0.001）。结论我们观察到，在一个社会措施严格、社区传播率低、死亡率没有过高的国家，COVID-19爆发期间ACS住院率下降。避免医疗护理行为是这些观察结果的一个重要因素，而由于自我隔离/自我隔离导致的ACS发病率的真正降低也可能发挥了作用。
Background Reports from countries severely hit by the COVID-19 pandemic suggest a decline in acute coronary syndrome (ACS)-related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID-19 incidence are not known. Hypothesis ACS admissions were reduced in a country spared by COVID-19. Methods We conducted a nationwide study on the incidence rates of ACS-related admissions during a 6-week period of the COVID-19 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID-19 incidence, and no excess in mortality. Results ACS admissions in the COVID-19 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72,P < .001) and for each ACS type (ST-segment elevation myocardial infarction [STEMI]: IRR: 0.76,P= .001; non-STEMI: IRR: 0.74,P < .001; and unstable angina [UA]: IRR: 0.63,P= .002). The decrease in STEMI admissions was stable throughout the COVID-19 period (temporal correlation; R-2= 0.11,P= .53), whereas there was a gradual decline in non-STEMI/UA admissions (R-2= 0.75,P= .026) following the progressively stricter social measures. During the COVID-19 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period;P < .001). Conclusions We observed a reduction in ACS hospitalizations during the COVID-19 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self-isolation/quarantining may have also played a role.