Objective Most reports on the declining incidence of myocardial infarction (MI) during the COVID-19 have either been anecdotal, survey results or geographically limited to areas with lockdowns. We examined the incidence of MI during the COVID-19 pandemic in Sweden, which has remained an open society with a different public health approach fighting COVID-19.
Methods We assessed the incidence rate (IR) as well as the incidence rate ratios (IRRs) of all MI referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR), during the COVID-19 pandemic in Sweden (1 March 2020–7 May 2020) in relation to the same days 2015–2019.
Results A total of 2443 MIs were referred for coronary angiography during the COVID-19 pandemic resulting in an IR 36 MIs/day (204 MIs/100 000 per year) compared with 15 213 MIs during the reference period with an IR of 45 MIs/day (254 MIs/100 000 per year) resulting in IRR of 0.80, 95% CI (0.74 to 0.86), p<0.001. Results were consistent in all investigated patient subgroups, indicating no change in patient category seeking cardiac care. Kaplan-Meier event rates for 7-day case fatality were 439 (2.3%) compared with 37 (2.9%) (HR: 0.81, 95% CI (0.58 to 1.13), p=0.21). Time to percutaneous coronary intervention (PCI) was shorter during the pandemic and PCI was equally performed, indicating no change in quality of care during the pandemic.
Conclusion The COVID-19 pandemic has significantly reduced the incidence of MI referred for invasive treatment strategy. No differences in overall short-term case fatality or quality of care indicators were observed.
- acute myocardial infarction
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Contributors All authors were involved in the study design, data analysis and revision of the manuscript. All authors read and approved the final manuscript. DE is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding This work was supported by the Swedish Heart and Lung Foundation, Swedish Scientific Research Council, Swedish foundation for strategic research SSF (TOTAL-AMI), Knut and Alice Wallenberg Foundation, Avtal om läkarutbildning och forskning ALF, the Bundy Academy and Skåne University Hospital funds. The sponsors had no involvement in the study design, collection, analysis or interpretation of data or writing of the manuscript or in the decision to submit manuscript for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The Regional Ethical Review Board in Lund approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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