Dear editor: The first patient with Covid-19 in Mexico was detected in late February 2020 and the Mexican government implemented measures to decrease the spread of SARS-CoV-2 infection. In order to describe the impact of coronavirus disease 2019 (Covid-19) outbreak in patients with acute myocardial infarction (AMI) in a university hospital in Mexico City, we compared the number and management of patients hospitalized for AMI (ST-segment elevation myocardial infarction [STEMI] or non-ST-segment elevation myocardial infarction [NSTEMI]) during the Covid-19 outbreak (10 weeks, from March 23 to May 31, 2020) with those in the 12 weeks before the pandemic (from January 1 to March 22, 2020) and in the same 10 weeks of the previous year, 2019 (from March 23 to May 31, 2019).
A total of 513 patients with AMI were included (STEMI, 349; NSTEMI, 164). A comparison of the periods before and after the lockdown began on March 23, 2020 showed that hospitalizations for AMI declined by 42.5% during the lockdown (10.8 patients per week vs. 18.8 per week before the lockdown) and by 39.6% (10.8 vs. 17.9 patients per week, respectively) compared with the same period in 2019 (figure 1A). The proportion of STEMI patients who did not receive reperfusion therapy was higher; furthermore, primary percutaneous coronary intervention reperfusion therapy decreased significantly (47.2% during the pandemic vs. 92.8% prior to the pandemic and 96.0% in 2019), while the administration of fibrinolytic therapy increased substantially (52.8 vs. 7.2 and 4%, respectively) (figure 1B). In patients with NSTEMI, the same pattern was observed (figure 1C).1
AMI: acute myocardial infarction STEMI: ST-segment elevation myocardial infarction NSTEMI: non-ST-segment elevation myocardial infarction
Large cities in Europe and the United States have reported similar circumstances and this prompts the question: what has happened to AMI patients and what do we expect in the future?2,3 Programs for the care of patients with AMI are still being implemented and improved in low- and middle-income countries and there has been a significant increase in the performance of primary PCI.4 Unfortunately, with the current Covid-19 pandemic, these achievements could well be reversed. The impact that Covid-19 will have on socially disadvantaged groups with AMI remains unclear; however, we must be prepared for a rise in patients with complications because the lack of optimal AMI care during the pandemic.