Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Eric Van Belle; Thibault Manigold; Adeline Piérache; Alain Furber; Nicolas Debry; Anne Luycx-Bore; Jean-Jacques Bauchart; Olivier Nugue; François Huchet; Mathieu Bic; François Vinchon; Smaïn Sayah; Alexandre Fournier; Eric Decoulx; Usman Mouhammad; Jérôme Clerc; Aurélie Manchuelle; Tahar Lazizi; Akram Chmait; Julien Jeannetteau; Pierre Hénon; Mickael Bonin; Marie Dupret-Minet; Ashok Tirouvanziam; David Molcard; Fabien Arabucki; Antoine Py; Fabrice Prunier; Cédric Delhaye; Gilles Lemesle; Guillaume Schurtz; Alessandro Cosenza; Hugues Spillemaeker; Basile Verdier; Tom Denimal; Thibault Pamart; Habib Sylla; Dany Janah; David Aouate; Sina Porouchani; Valérie Guillez; Guillaume Bonnet; Julien Ternacle; Julien Labreuche; Guillaume Cayla; Flavien Vincent

doi:10.1016/j.lanepe.2021.100030

Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study

Lancet Reg Health Eur. 2021 Mar:2:100030. doi: 10.1016/j.lanepe.2021.100030. Epub 2021 Jan 13.

Authors

Eric Van Belle¹, Thibault Manigold², Adeline Piérache³, Alain Furber⁴, Nicolas Debry⁵, Anne Luycx-Bore⁶, Jean-Jacques Bauchart⁷, Olivier Nugue⁸, François Huchet⁹, Mathieu Bic¹⁰, François Vinchon¹¹, Smaïn Sayah¹², Alexandre Fournier¹³, Eric Decoulx¹⁴, Usman Mouhammad¹⁵, Jérôme Clerc¹⁶, Aurélie Manchuelle¹⁷, Tahar Lazizi¹⁸, Akram Chmait¹⁹, Julien Jeannetteau²⁰, Pierre Hénon²¹, Mickael Bonin², Marie Dupret-Minet²², Ashok Tirouvanziam²³, David Molcard²⁴, Fabien Arabucki²⁵, Antoine Py²⁶, Fabrice Prunier⁴, Cédric Delhaye¹, Gilles Lemesle¹, Guillaume Schurtz¹, Alessandro Cosenza¹, Hugues Spillemaeker¹, Basile Verdier¹, Tom Denimal¹, Thibault Pamart¹, Habib Sylla¹, Dany Janah¹, David Aouate¹, Sina Porouchani¹, Valérie Guillez¹, Guillaume Bonnet²⁷, Julien Ternacle²⁷, Julien Labreuche³, Guillaume Cayla²⁸, Flavien Vincent¹

Affiliations

¹ CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille 59037, France.
² CHU Nantes, Nantes, France.
³ Département de Biostatistiques, Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
⁴ Cardiologie, CHU Angers, France.
⁵ CH Saint-Philibert, Lille, France.
⁶ CH Beauvais, Beauvais, France.
⁷ Clinique la Louvière, Lille, France.
⁸ Centre hospitalier Boulogne, France.
⁹ CH Saint-Nazaire, France.
¹⁰ CH Lens, France.
¹¹ CH Le Mans, France.
¹² CH Creil, France.
¹³ CHU Amiens, France.
¹⁴ CH Roubaix, France.
¹⁵ CH Valenciennes, France.
¹⁶ CH Compiègne, France.
¹⁷ Clinique Bois Bernard, France.
¹⁸ CH Laval, France.
¹⁹ Clinique Côte d'Opale, Saint-Martin Boulogne, France.
²⁰ Clinique Saint-Joseph, Angers, France.
²¹ CH Saint-Quentin, France, France.
²² CH Dunkerque, France, France.
²³ Polyclinique du Confluent, Nantes, France.
²⁴ CH Soissons, France.
²⁵ CH La Roche Sur Yon, France.
²⁶ Clinique Victor Pauchet, Amiens, France.
²⁷ Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France.
²⁸ CHU Nîmes, France.

Abstract

Background: A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided.

Methods: To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern "Hauts-de-France" province and western "Pays-de-la-Loire" Province. The incidence of COVID-19 fatalities was also collected.

Findings: In "Hauts-de-France", during lockdown (March 18-May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71-0.84, p<0.001) was observed for a loss of 272 MIs (95%CI:-363,-181), representing 18% of COVID-19-related deaths. In "Pays-de-la-Loire", 382 COVID-19-related deaths were observed. A 19% decrease in MI-IR (IRR=0.81; 95%CI=0.73-0.90, p<0.001) was observed for a loss of 138 MIs (95%CI:-210,-66), representing 36% of COVID-19-related deaths. While in "Hauts-de-France" the MI decline started before lockdown and recovered 3 weeks before its end, in "Pays-de-la-Loire", it started after lockdown and recovered only by its end. In-hospital mortality of MI patients was increased during lockdown in both provinces (5.0% vs 3.4%, p=0.02).

Interpretation: It highlights one of the potential collateral damages of COVID-19 outbreak on cardiovascular health with a dramatic reduction of MI incidence. It advocates for a careful and weighted communication strategy in pandemic crises.

Funding: The study was conducted without external funding.

Keywords: COVID-19 outbreak; COVID-19, Coronavirus disease 2019; Clinical outcome; MI, Myocardial Infarction; Mortality; Myocardial Infarction; NSTEMI, non ST-segment elevation myocardial infarction; STEMI, ST-segment elevation myocardial infarction.