Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic review and meta-analysis

Francesco Sofi; Monica Dinu; GianPaolo Reboldi; Fabrizio Stracci; Roberto F E Pedretti; Serafina Valente; GianFranco Gensini; C Michael Gibson; Giuseppe Ambrosio

doi:10.1016/j.ijcard.2021.10.156

Worldwide differences of hospitalization for ST-segment elevation myocardial infarction during COVID-19: A systematic review and meta-analysis

Int J Cardiol. 2022 Jan 15:347:89-96. doi: 10.1016/j.ijcard.2021.10.156. Epub 2021 Nov 2.

Authors

Francesco Sofi¹, Monica Dinu¹, GianPaolo Reboldi², Fabrizio Stracci³, Roberto F E Pedretti⁴, Serafina Valente⁵, GianFranco Gensini⁴, C Michael Gibson⁶, Giuseppe Ambrosio⁷

Affiliations

¹ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
² Department of Medicine, University of Perugia School of Medicine, Perugia, Italy; Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy.
³ Department of Medicine, University of Perugia School of Medicine, Perugia, Italy.
⁴ IRCCS MultiMedica, Milan, Italy.
⁵ Cardiology, Siena University Hospital, Siena, Italy.
⁶ Baim Institute for Clinical Research, Harvard Medical School, Boston, MS, United States of America.
⁷ Center for Clinical and Translational Research-CERICLET, University of Perugia School of Medicine, Perugia, Italy; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. Electronic address: giuseppe.ambrosio@unipg.it.

Abstract

Background: Discrepant data were reported about hospital admissions for ST-segment elevation myocardial infarction (STEMI) during COVID-19 pandemic. We reviewed studies reporting STEMI hospitalizations during COVID-19 pandemic, investigating whether differences in COVID-19 epidemiology or public health-related factors could explain discrepant findings in different countries.

Methods: Search through MedLine, Embase, Scopus, Web-of-Science, Cochrane Register of Controlled Trials, of studies comparing STEMI admissions during COVID-19 pandemic with a reference period, without language restrictions, as registered in PROSPERO International Prospective Register of Systematic Reviews. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Data independently extracted by multiple investigators were pooled using a random-effects model. Health-related metrics were from publicly-available sources.

Results: We included 79 articles (111,557 STEMI cases, from 57 countries). During peak COVID-19 pandemic, overall incidence rate-ratio (IRR) of STEMI hospitalizations over reference period decreased (0.80; 95% CI 0.76-0.84; p < 0.05). Although wide variations and significant heterogeneity were detected among studies (I² = 89%; p < 0.0001), no significant differences were observed by report methodology (survey vs registry), or observation/reference period. However, large differences emerged at country level not explained by COVID-related epidemiological data, nor by public health strategies. Instead, IRRs for STEMI admissions were inversely related to hospital bed availability in each country (p < 0.05).

Conclusions: During COVID-19 pandemic hospitalization for STEMI significantly decreased, although to a smaller extent than initially reported. Large variability emerged across countries, unrelated to COVID-related epidemiology or social containment measures. Disparities in healthcare organization likely contributed, indicating that proper organization of emergency medicine should be preserved during pandemics.

Keywords: Acute coronary syndromes; COVID-19; Healthcare organization; Myocardial infarction; STEMI; Sars-Cov-2.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

COVID-19*
Hospitalization
Humans
Pandemics
Percutaneous Coronary Intervention*
SARS-CoV-2
ST Elevation Myocardial Infarction* / diagnosis
ST Elevation Myocardial Infarction* / epidemiology