Incidence of acute myocardial infarction-related cardiogenic shock during corona virus disease 19 (COVID-19) pandemic

M D Lauridsen; J H Butt; L Østergaard; J E Møller; C Hassager; T Gerds; K Kragholm; M Phelps; M Schou; C Torp-Pedersen; G Gislason; L Køber; E L Fosbøl

doi:10.1016/j.ijcha.2020.100659

Incidence of acute myocardial infarction-related cardiogenic shock during corona virus disease 19 (COVID-19) pandemic

Int J Cardiol Heart Vasc. 2020 Dec:31:100659. doi: 10.1016/j.ijcha.2020.100659. Epub 2020 Oct 13.

Authors

M D Lauridsen¹, J H Butt¹, L Østergaard¹, J E Møller^{1

2}, C Hassager^{1

3}, T Gerds^{4

5}, K Kragholm⁶, M Phelps⁵, M Schou⁷, C Torp-Pedersen⁸, G Gislason^{5

7}, L Køber^{1

3}, E L Fosbøl¹

Affiliations

¹ Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
² Department of Cardiology, Odense University Hospital, Odense, Denmark.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Department of Biostatistics, Copenhagen University, Copenhagen, Denmark.
⁵ The Danish Heart Foundation, Copenhagen, Denmark.
⁶ Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
⁷ Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.
⁸ Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark.

Abstract

Aims: The hospitalization of patients with MI has decreased during global lockdown due to the COVID-19 pandemic. Whether this decrease is associated with more severe MI, e.g. MI-CS, is unknown. We aimed to examine the association of Corona virus disease (COVID-19) pandemic and incidence of acute myocardial infarction with cardiogenic shock (MI-CS).

Methods: On March 11, 2020, the Danish government announced national lock-down. Using Danish nationwide registries, we identified patients hospitalized with MI-CS. Incidence rates (IR) and incidence rate ratios (IRR) were used to compare MI-CS before and after March 11 in 2015-2019 and in 2020.

Results: We identified 11,769 patients with MI of whom 696 (5.9%) had cardiogenic shock in 2015-2019. In 2020, 2132 MI patients were identified of whom 119 had cardiogenic shock (5.6%). The IR per 100,000 person years before March 11 in 2015-2019 was 9.2 (95% CI: 8.3-10.2) and after 8.9 (95% CI: 8.0-9.9). In 2020, the IR was 7.5 (95% CI: 5.8-9.7) before March 11 and 7.7 (95% CI: 6.0-9.9) after. The IRRs comparing the 2020-period with the 2015-2019 period before and after March 11 (lockdown) were 0.81 (95% CI: 0.59-1.12) and 0.87 (95% CI: 0.57-1.32), respectively. The IRR comparing the 2020-period during and before lockdown was 1.02 (95% CI: 0.74-1.41). No difference in 7-day mortality or in-hospital management was observed between study periods.

Conclusion: We could not identify a significant association of the national lockdown on the incidence of MI-CS, along with similar in-hospital management and mortality in patients with MI-CS.

Keywords: CABG, Coronary artery bypass grafting; CAG, Coronary angiography; COVID-19; COVID-19, Corona Virus disease; Cardiogenic shock; Corona virus; ECMO, Extra-corporeal membrane oxygenation; IABP, Intra-aortic balloon pump; ICD, International Classification of Diseases; Incidence; MI, Acute myocardial infarction; MI-CS, Acute myocardial infarction-related cardiogenic shock; Myocardial infarction; PCI, Percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.