"Missing" acute coronary syndrome hospitalizations during the COVID-19 era in Greece: Medical care avoidance combined with a true reduction in incidence?
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Papafaklis Michail I, Katsouras Christos S, Tsigkas Grigorios, Toutouzas Konstantinos, Davlouros Periklis, Hahalis George N, Kousta Maria S, Styliadis Ioannis G, Triantafyllou Konstantinos, Pappas Loukas, Tsiourantani Fotini, Varytimiadi Efthymia, Anyfantakis Zacharias-Alexandros, Iakovis Nikolaos, Grammata Paraskevi, Karvounis Haralambos, Ziakas Antonios, Sianos George, Tziakas Dimitrios, Pappa Evgenia, Dagre Anna, Patsilinakos Sotirios, Trikas Athanasios, Lamprou Thomais, Mamarelis Ioannis, Katsimagklis Georgios, Karmpaliotis Dimitri, Naka Katerina, Michalis Lampros K
Аннотация
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; R2 = 0.11, P = .53), whereas there was a gradual decline in non-STEMI/UA admissions (R2 = 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.