Presentations for Acute MIs Dropped Drastically During Peak of COVID-19 Pandemic

Nina Talmor, MD

While it appears medicine is starting to see light at the end of the tunnel for the COVID-19 pandemic, clinicians and researchers are just beginning to uncover the multitude of lessons that can be taken from the pandemic.

One of the most perplexing lessons to come from the pandemic could relate to heart attack presentations in emergency departments. While early data suggested fear of COVID-19 may have been keeping patients from seeking necessary attention, some have begun to theorize clinicians may have been overdiagnosing these events.

Now, a study presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions is diving deeper into the issue and providing insight from a hospital center based in New York City.

“We were surprised to observe a significant reduction in the number of patients referred for coronary management of MI; this suggests that many patients may have stayed at home despite their symptoms of a heart attack,” said Nina Talmor, MD, lead investigator and internal medicine resident at NYU Langone Health, in a statement. “Our findings point to the need for improved public health messaging for future health crises, so that people do not remain at home out of fear, rather than seeking necessary and potentially lifesaving care. We hope our study will bring awareness to the need for timely cardiac care both in and out of a pandemic.”

To learn more about the reductions in patients presenting with acute myocardial infarction, Talmor and a team of colleagues designed the current study as a single-center, retrospective analysis of data from NYU Langone Health. Using the month of April in 2019 and 2020 as the time periods of inters, investigators performed an electronic medical record review to identify all STEMI and NSTEMI patients referred for invasive coronary angiography.

During April 2019, 59 patients presented with acute myocardial infarction, including 47 with NSTEMI and 12 with STEMI. During April 2020, 13 patients presented with acute myocardial infarction, including 7 with NSTEMI and 5 with STEMI. Overall, this represents a reduction of 78%. Investigators noted 2 of the 13 patients presenting with acute myocardial infarction in April 2020 tested positive for COVID-19.

Despite the decrease in acute myocardial infarction, investigators noted there were no significant differences in baseline demographics, comorbidities, or medication use between the study groups. investigators pointed out patients in 2020 had a longer median delay from symptom onset to hospital presentation (70.7 vs 34.2 hours; P=.06).

Further analysis indicated multivessel coronary disease was more prevalent during 2019 than 2020 (73% vs 31%; P=.01). When assessing for potential differences in troponin levels, investigators found initial troponin levels were similar with a mean of 5.98 ng/mL and 3.02 ng/mL in 2019 and 2020, respectively. In contrast, investigators found peak troponin feels were significantly higher among patients presenting during the pandemic compared to those presenting in 2019 (2019: 19.49 ng/mL; 2020: 83.92 ng/mL).

Additionally, investigators noted there were no significant differences in patient outcomes between the study groups. Specifically, the median length of stay was 3 days in 2019 and 4 days in 2020 and in-hospital death occurred in 6.8% of patients in 2019 and 7.7% in 2020.

This study, “Where Did All the Acute Myocardial Infarctions Go? Fewer Presentations During the Initial Wave of the COVID-19 Pandemic,” was presented at SCAI 2021.