Association Between Air Pollution and Acute Coronary Syndromes During Lockdown for COVID-19: Results From the Terni Hub Center

Impact of recurrent COVID-19 disease waves on acute myocardial infarction epidemics: results from a regional network

Aims: To assess the impact of COVID-19 related public containment measures during recurrent COVID-19 waves on hospital admission rate for acute myocardial infarction (AMI).Methods and results: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive AMI patients who were admitted in a regional AMI network were recorded during one year starting in March 2020 and were compared with the year before. The COVID-19 study period encompassed two waves: the first in March-May 2020 and the second in October-December 2020. A total of 1349 AMI patients were hospitalised of which 725 during the pre-COVID period and 624 during the COVID period (incidence rate ratio of 1.16, p = 0,006). The impact was predominantly present in the first wave (32% reduction: n = 204 vs 152) and evanished during the second wave (3% increase (152 vs 156). A similar pattern was observed for ACS with cardiac arrest with a 92% reduction (n = 36 vs 3) during the first wave and no change during the second wave (18 vs 18). After correction for temperature and air quality, COVID-19 epidemic remained associated with a decrease of AMI hospitalisation (p = 0.046). Reperfusion strategy for AMI patients, were comparable between both study periods. The in-hospital mortality between the two periods was comparable (2.6% versus 1.9%), but COVID-19 positive ACS patients (n = 7) had a high mortality rate (14%).Conclusion: COVID-19 related public containment measures resulted during the first wave in a 32% reduction of AMI hospitalisation, but this impact was not visible anymore during the second wave.

Relationships between the COVID-19 lockdown, socioeconomic factors and acute coronary syndrome hospitalisations in France

INTRODUCTION

Worldwide, the COVID-19 pandemic has been associated with an overall drop in acute coronary syndrome (ACS) hospitalizations. Additionally, there is a well-known association between ACS and socioeconomic status. This study aims to assess the COVID-19 effect on ACS admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity.

MATERIALS AND METHODS

In this retrospective study, we used the French hospital discharge database (PMSI) to estimate ACS admission rates in all public and private hospitals in 2019 and 2020. A negative binomial regression explored the nationwide change in ACS admissions during lockdown compared with 2019. A multivariate analysis explored the factors associated with the ACS admission incidence rate ratio (IRR, 2020 incidence rate/2019 incidence rate) variation at the county level.

RESULTS

We found a significant but geographically heterogeneous nationwide reduction in ACS admissions during lockdown (IRR 0·70 [0·64-0·76]). After adjustment for cumulative COVID-19 admissions and the ageing index, a higher share of people on short-term working arrangements during lockdown at the county level was associated with a lower IRR, while a higher share of individuals with a high school degree and a higher density of acute care beds were associated with a higher ratio.

CONCLUSIONS

During the first national lockdown, there was an overall decrease in ACS admissions. Local provision of inpatient care and socioeconomic determinants linked to occupation were independently associated with the variation in hospitalizations.

Impact of Air Pollution and COVID-19 Infection on Periprocedural Death in Patients with Acute Coronary Syndrome

Air pollution and COVID-19 infection affect the pathogenesis of cardiovascular disease. The impact of these factors on the course of ACS treatment is not well defined. The purpose of this study was to evaluate the effects of air pollution, COVID-19 infection, and selected clinical factors on the occurrence of perioperative death in patients with acute coronary syndrome (ACS) by developing a neural network model. This retrospective study included 53,076 patients with ACS from the ORPKI registry (National Registry of Invasive Cardiology Procedures) including 2395 COVID-19 (+) patients and 34,547 COVID-19 (-) patients. The neural network model developed included 57 variables, had high performance in predicting perioperative patient death, and had an error risk of 0.03%. Based on the analysis of the effect of permutation on the variable, the variables with the greatest impact on the prediction of perioperative death were identified to be vascular access, critical stenosis of the left main coronary artery (LMCA) or left anterior descending coronary artery (LAD). Air pollutants and COVID-19 had weaker effects on end-point prediction. The neural network model developed has high performance in predicting the occurrence of perioperative death. Although COVID-19 and air pollutants affect the prediction of perioperative death, the key predictors remain vascular access and critical LMCA or LAD stenosis.

Fear of COVID-19 in Patients with Acute Myocardial Infarction

A marked decline in myocardial infarction (AMI) hospitalizations was observed worldwide during the COVID-19 outbreak. The pandemic may have generated fear and adverse psychological consequences in these patients, delaying hospital access. The main objective of the study was to assess COVID fear through the FCV-19S questionnaire (a self-report measure of seven items) in 69 AMI patients (65 ± 11 years, mean ± SD; 59 males). Females presented higher values of each FCV-19S item than males. Older subjects (>57 years, 25th percentile) showed a higher total score with respect to those in the first quartile. The percentage of patients who responded “agree” and “strongly agree” in item 4 (“I am afraid of losing my life because of the coronavirus”) and 3 (“My hands become clammy when I think about the coronavirus”) was significantly greater in the elderly than in younger patients. When cardiovascular (CV) patients were compared to a previously published general Italian population, patients with CV disease exhibited higher values for items 3 and 4. Measures should be put in place to assist vulnerable and high CV risk patients, possibly adding psychologists to the cardiology team.