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

Eric van Belle (1, 2) , Thibault Manigold (3) , Adeline Piérache (1, 4) , Alain Furber (5) , Nicolas Debry (1) , Anne Luycx-Bore (6) , Jean-Jacques Bauchart (7) , Olivier Nugue (8) , François Huchet (9) , Mathieu Bic (10) , François Vinchon (11) , Smaïn Sayah (12) , Alexandre Fournier (13) , Eric Decoulx (14) , Usman Mouhammad (15) , Jérôme Clerc (16) , Aurélie Manchuelle (17) , Tahar Lazizi (18) , Akram Chmait , Julien Jeannetteau (19) , Pierre Hénon (20) , Mickael Bonin (3) , Marie Dupret-Minet (21) , Ashok Tirouvanziam (22) , David Molcard , Fabien Arabucki (23) , Antoine Py , Fabrice Prunier (5) , Cédric Delhaye (1, 2, 24) , Gilles Lemesle (1, 2, 24) , Guillaume Schurtz (1, 24) , Alessandro Cosenza (1, 24) , Hugues Spillemaeker (1, 24) , Basile Verdier (1, 24) , Tom Denimal (1, 24) , Thibault Pamart (1, 24) , Habib Sylla (1, 24) , Dany Janah (1, 24) , David Aouate (1, 24) , Sina Porouchani (24, 1) , Valérie Guillez (1, 24) , Guillaume Bonnet (25) , Julien Ternacle (25) , Julien Labreuche (1, 4) , Guillaume Cayla (26) , Flavien Vincent (24, 1)

1 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
2 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U1011
3 CHU Nantes - Centre Hospitalier Universitaire de Nantes
4 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 Centre Hospitalier Simone Veil de Beauvais [Beauvais]
7 Ramsay Générale de Santé - Hôpital Privé La Louvière
8 Centre Hospitalier Boulogne-sur-mer
9 Centre hospitalier de Saint-Nazaire
10 Centre Hospitalier de Lens
11 Centre Hospitalier Le Mans (CH Le Mans)
12 GHPSO - Groupe Hospitalier Public du Sud de l'Oise [Creil]
13 CHU Amiens-Picardie
14 Centre Hospitalier de Roubaix
15 Centre hospitalier [Valenciennes, Nord]
16 CHCN - Centre Hospitalier Compiègne-Noyon
17 Hôpital privé de Bois-Bernard - Ramsay Santé [Bois-Bernard]
18 CH Laval - Centre Hospitalier de Laval
19 Clinique Saintt Joseph
20 VIP - Centre de recherche Versailles Saint-Quentin Institutions Publiques
21 CH Dunkerque
22 Hôpital privé du Confluent [Nantes]
23 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
24 Institut Coeur Poumon [CHU Lille]
25 CHU Bordeaux
26 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes

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.

Mots clés: COVID-19 outbreak; Myocardial Infarction; Mortality; Clinical outcome

Domaines: Cardiologie et système cardiovasculaire; Santé publique et épidémiologie; Maladies infectieuses; Maladies émergentes

Eric van Belle, Thibault Manigold, Adeline Piérache, Alain Furber, Nicolas Debry, et al.. Myocardial Infarction incidence during national lockdown in two French provinces unevenly affected by COVID-19 outbreak: An observational study. The Lancet Regional Health - Europe, 2021, 2, pp.100030. ⟨10.1016/j.lanepe.2021.100030⟩. ⟨hal-03638773⟩