Portal de Periódicos da CAPES

Impact of two COVID-19 national lockdowns on acute coronary syndrome admissions

2021; Lippincott Williams & Wilkins; Volume: 33; Issue: 4 Linguagem: Inglês

10.1097/mca.0000000000001094

1473-5830

Marie Hauguel‐Moreau, G Prati, Rémy Pillière, Sébastien Beaune, Thomas Loeb, Bruno Sawczynski, Vincent Aïdan, Hélène Hergault, Mounir Ouadahi, Catherine Szymanski, Olivier Dubourg, Nicolas Mansencal,

Infection Control and Ventilation

To The Editors During the first COVID-19 lockdown, a significant decrease in acute coronary syndrome (ACS) admissions was observed [1,2]. Many reasons were hypothesized: decreased ACS occurrence because of environmental factors (lower pollution rate, lower daily stressors, more sleeping time) or underdiagnosed ACS (fear of contracting SARS-CoV-2 at hospital and avoidance of medical care) that might lead to an increase in fatal ACS cases [3). Furthermore, the first lockdown was associated with a four-time increase in total ischemic time in patients with ST-elevation myocardial infarction (STEMI), and thus an increased occurrence of mechanical complications [2]. At the time of the second lockdown, fear was great, in the medical community, to experience such a situation. Here we report a high-volume coronary care unit experience of patients hospitalized for ACS during the second lockdown (28 September to 13 December 12020), as compared to the first one (17 February to 26 April 2020). We compared hospitalization rates for ACS in 2020 to the same period in 2018 and 2019. We calculated incidence rates by dividing the number of admissions by the number of weeks for each time period. The incidence rate ratio comparing the 2020 period to 2018/2019 was calculated using the Poisson regression. During the second lockdown, the number of ACS admissions were 64 (28.1% women, median age: 70.1 years) versus 133 (30.3% women, median age: 68.1 years) for the same 2018–2019 period. The proportion of STEMI among ACS did not differ between years: 32 out of 64 (50%) in 2020 versus 69 out of 133 (52%) in 2018/2019 (P = 0.8). The mean admission rate for ACS during the 2020 period was 5.8 admissions per week and did not differ with the control period [5.9 admissions per week; incidence rate ratio = 0.96 (0.90–0.99), P = 0.62]. In patients with STEMI, median symptom-onset to first medical contact (FMC) did not differ between 2020 and 2018/2019 [125 min (51–254) versus 121 min (49–290), P = 0.7], as well as median FMC-to-sheath insertion [92 min (81–136) in 2020 versus 90 min (70–131) in 2018–2019, P = 0.8]. Mean left ventricular ejection fraction (LVEF) was 52 ± 12% in 2020 versus 51 ± 11% in 2018–2019 (P = 0.9). In-hospital mortality did not differ between years [6.3% (n = 4) in 2020 versus 4.5% (n = 6) in 2018–2019, P = 0.6). Five patients suffering from COVID-19 presented with ACS during the second lockdown. During the first lockdown [2], we found a first significant fall in ACS admission, with a relative reduction of 73%. Median symptom-onset-to-FMC time was 600 min (versus 125 min for the second lockdown, P < 0.001) and mean LVEF was 38 ± 14% (versus 52 ± 12% for the second lockdown, P < 0.01). Evolution of ACS admissions during the two lockdowns and in 2018–2019 is presented in Fig. 1.Contrary to first lockdown, we observed no change in ACS admissions during the second COVID-19 lockdown. To our knowledge, this is the first study to report the impact of the second lockdown on ACS admissions. Indirect cardiovascular effects associated with first lockdown (dramatic decline in ACS admissions, higher patient-related ischemic time in STEMI, increase in out-of-hospital cardiac arrests) [1–3] were taken into consideration at the time of the second lockdown. Interestingly, we found that ischemic time did not differ during second lockdown, as compared to previous years, contrary to the first one. The medical community, media and politics sent out a strong prevention warning to patients that seem to have been heard.Fig. 1: Admissions of acute coronary syndrome during the COVID-19 first (a) and second (b) national lockdowns, 4 weeks before the two lockdowns, and during the same 2018–2019 periods. Green hatched lines represent the 4-week period consecutive to the first lockdown (on 17 March 2020), with a dramatic decline in ACS admissions. ACS, acute coronary syndrome.Lockdown is associated with lower pollution rates, lower daily stressors and more sleeping time and may have beneficial effects on the cardiovascular system. However, these potential beneficial effects are counterbalanced by COVID-19 socioeconomic damages and impaired mental health that may have enhanced stress [4], leading to promote ACS. Another explanation for this 'normality' in ACS admissions during this second lockdown in France is that the lockdown was not as strict as the first one. We report a monocentric experience and our findings need further validation. However, the second COVID-19 lockdown in France may not have any measurable short-term impact on ACS admissions as compared to the first lockdown where a decrease in ACS was noted. It seems that coronary patients heard warning from the medical community edited after the first wave COVID-19 pandemic. Acknowledgements The study protocol was approved by the Institutional Data Protection Authority of Paris Saclay University Hospitals. The authors received no financial support for the research, authorship and/or publication of this article. M.H.M., N.M., O.D. and C.S. contributed to the conception and design of the study. M.H.M., S.B., T.L., B.S., V.A., G.P. and R.P. contributed to the acquisition and analysis of data. M.H.M. drafted the manuscript. V.A., H.H., M.O., O.D. and N.M. critically revised the manuscript. All authors gave final approval of the article and agree to be accountable for all aspects of work ensuring integrity and accuracy. Data may be obtained from a third party and are not publicly available. Conflicts of interest There are no conflicts of interest.