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Original research
Incidence and outcome of myocardial infarction treated with percutaneous coronary intervention during COVID-19 pandemic
  1. Moman A Mohammad1,
  2. Sasha Koul1,
  3. Göran K Olivecrona1,
  4. Matthias Gӧtberg1,
  5. Patrik Tydén1,
  6. Erik Rydberg1,
  7. Fredrik Scherstén1,
  8. Joakim Alfredsson2,
  9. Peter Vasko3,
  10. Elmir Omerovic4,
  11. Oskar Angerås4,
  12. Ole Fröbert5,
  13. Fredrik Calais5,
  14. Sebastian Völz4,
  15. Anders Ulvenstam6,
  16. Dimitrios Venetsanos7,
  17. Troels Yndigegn1,
  18. Jonas Oldgren8,
  19. Giovanna Sarno8,
  20. Per Grimfjärd9,
  21. Jonas Persson10,
  22. Nils Witt11,
  23. Ellen Ostenfeld12,
  24. Bertil Lindahl8,
  25. Stefan K James8,
  26. David Erlinge1
  1. 1Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
  2. 2Department of Cardiology, Linköping University, Linköping, Sweden
  3. 3Department of Medicine, Växjö Hospital, Växjö, Sweden
  4. 4Department of Cardiology, Department of Molecular and Clinical Medicine, Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine,Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  5. 5Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
  6. 6Department of Cardiology, Östersund Hospital, Östersund, Sweden
  7. 7Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  8. 8Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  9. 9Department of Internal Medicine, Västmanlands Sjuk, Lund, Sweden
  10. 10Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockolm, Sweden
  11. 11Dvision of Cardiology, Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
  12. 12Department of Clinical Physiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
  1. Correspondence to Dr David Erlinge, Department of Clinical Science, Lund University, Lund, Sweden; david.erlinge{at}


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
  • epidemiology

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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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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