Marc J Claeys1, Jean-François Argacha2, Philippe Collart3, Marc Carlier4, Olivier Van Caenegem5, Peter R Sinnaeve6, Walter Desmet6, Philippe Dubois7, Francis Stammen8, Sofie Gevaert9, Suzanne Pourbaix10, Patrick Coussement11, Christophe Beauloye12, Patrick Evrard13, Olivier Brasseur14, Frans Fierens15, Patrick Marechal16, Dan Schelfaut17, Vincent Floré18, Claude Hanet19. 1. Department of Cardiology, University Hospital Antwerp, Antwerp, Belgium. 2. Department of Cardiology, University Hospital Brussels, Brussels, Belgium. 3. Centre de recherche en Epidémiologie, Biostatistiques et Recherche Clinique, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium. 4. Department of Cardiology, GHDC, Charleroi, Belgium. 5. Division of Cardiovascular Intensive Care, Cliniques universitaires Saint Luc, Brussels, Belgium. 6. Department of Cardiology, University Hospital Leuven, Leuven, Belgium. 7. Department of Cardiology, CHU, Charleroi, Belgium. 8. Department of Cardiology, Hospital Roeselare, Roeselare, Belgium. 9. Department of Cardiology, Ghent University Hospital, Ghent, Belgium. 10. Department of Cardiology, CHR Citadelle Liège, Liège, Belgium. 11. Department of Cardiology, Hospital Sint-Jan Brugge, Brugge, Belgium. 12. Division of Cardiology and Pole of Cardiovascular Research, Institut de Recherche Experimentale et Clinique, Cliniques universitaires Saint Luc, Brussels, Belgium. 13. Department of Intensive Care, Belgium Catholic University Hospital Mont-Godinne, Brussels, Belgium. 14. Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium. 15. Belgian Interregional Environment Agency, Brussels, Belgium. 16. Department of Cardiology, University hospital of Liege, Liège, Belgium. 17. Department of Cardiology, OLV Aalst, Aalst, Belgium. 18. Department of Cardiology, Hospital Maria Middelares, Ghent, Belgium. 19. Department of Cardiology, Catholic University Hospital Mont-Godinne, Brussels, Belgium.
Abstract
AIMS: The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p < .001). During the three-week period, there were 188 STEMI patients admitted for PCI during the lockdown versus an average 254 STEMI patients before the lockdown period (incidence rate ratio = 0.74, p = .001). Reperfusion strategy was predominantly primary PCI in both time periods (96% versus 95%). However, there was a significant delay in treatment during the lockdown period, with more late presentations (>12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION: The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation.
AIMS: The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium. METHODS AND RESULTS: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p < .001). During the three-week period, there were 188 STEMI patients admitted for PCI during the lockdown versus an average 254 STEMI patients before the lockdown period (incidence rate ratio = 0.74, p = .001). Reperfusion strategy was predominantly primary PCI in both time periods (96% versus 95%). However, there was a significant delay in treatment during the lockdown period, with more late presentations (>12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died. CONCLUSION: The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation.
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