Has COVID-19 affected regional mortality from acute coronary artery disease? (comparison of two periods of 2017-2019 and 2020-2022)

Aim. To assess the changes of mortality from acute coronary artery disease (CAD) in the Russian regions during the coronavirus disease 2019 (COVID-19) pandemic in 2020-2022 in comparison with the prepandemic period (2017-2019).

Material and methods. Rosstat data on the average annual population and mortality rate in one-year age groups for 82 regions Russian were used. In the brief Nomenclature of Causes of Death of Rosstat, the codes of the International Classification of Diseases, 10^th revision (ICD-10) are grouped as follows: I21.0-9 (acute primary) myocardial infarction (MI), I22.0-9 (recurrent MI), I20, I24.1-9 (other types of acute coronary artery disease), U07.1 and U07.2 (coronavirus disease 2019 (COVID-19)). The regional average standardized mortality rates (SMR; M±SD) were calculated using the European population standard using the direct standardization method per 100 thousand population. Comparisons were made using the nonparametric Wilcoxon t-test (differences were considered significant at p<0,05).

Results. A decrease in the regional average SMR (per 100 thousand population) in the pandemic compared to the pre-pandemic period was revealed: from the sum of all acute CAD types — from 51,24±31,98 to 50,21±33,38 and from repeated MI — from 7,65±5,42 to 4,80±4,84; increase in SMR from acute MI — from 24,00±10,1 to 25,57±11,55, from other acute CAD types — from 19,58±25,23 to 19,83±26,21. Significant regional variability was noted in both the dynamics of the SMR from three acute CAD types, as well as the minimum and maximum SMR. Only in 2 regions in the pandemic period there was an increase in SMR from each of the three acute CAD types compared to the pre-pandemic period. In 18 regions, there was a decrease in SMR from each of the three forms, and in the rest, multidirectional changes were noted. There was no correlation between SMR for COVID-19 and SMR for acute CAD (r=0,034; p=0,76).

Conclusion. The COVID-19 pandemic did not have a significant impact on the regional average SMR from acute CAD. The significant decrease in SMR from recurrent MI is likely due to choice of the initial cause of death.

1. Kole C, Stefanou E, Karvelas N, et al. Acute and Post-Acute COVID-19 Cardiovascular Complications: A Comprehensive Review. Cardiovasc Drugs Ther. 2023;20:1-16. doi:10.1007/s10557-023-07465-w.

2. Canalella A, Vitale E, Vella F, et al. How the Heart Was Involved in COVID-19 during the First Pandemic Phase: A Review. Epidemio-logia (Basel). 2021;22;2(1):124-39. doi:10.3390/epidemiologia2010011.

3. Roth G, Vaduganathan M, Mensah G, et al. Impact of the COVID-19 Pandemic on Cardiovascular Health in 2020. J Am Coll Cardiol. 2022;80(6)631-40. doi:10.1016/j.jacc.2022.06.008.

4. Guo H, Shen Y, Wu N, et al. Myocardial injury in severe and critical coronavirus disease 2019 patients. J Card Surg. 2021;36(1):82-8. doi:10.1111/jocs.15164.

5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. doi:10.1016/S0140-6736(20)30183-5.

6. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109:531-38. doi:10.1007/s00392-020-01626-9.

7. Liu PP, Blet A, Smyth D, et al. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation. 2020;142(1):68-78. doi:10.1161/CIRCULATIONAHA.120.047549.

8. Wang Z, Tang M, Luan X, et al. Editorial: What do we know about COVID-19 implications for cardiovascular disease? Front Cardiovasc Med. 2023;10:1125655. doi:10.3389/fcvm.2023.1125655.

9. Bonow RO, Fonarow GC, O'Gara PT, et al. Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality. JAMA Cardiol. 2020;5(7):751-3. doi:10.1001/jamacardio.2020.1105.

10. Xiong TY, Redwood S, Prendergast B, et al. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020;41(19):1798-800. doi:10.1093/eurheartj/ehaa231.

11. Liang C, Zhang W, Li S, et al. Coronary heart disease and COVID-19: A meta-analysis. Med Clin (Barc). 2021;156(11):547-54. doi:10.1016/j.medcli.2020.12.017.

12. Wadhera RK, Shen C, Gondi S, et al. Cardiovascular deaths during the COVID-19 pandemic in the United States. J Am Coll Cardiol. 2021;77:2:159-69. doi:10.1016/j.jacc.2020.10.055.

13. De Rosa S, Spaccarotella C, Basso C, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J. 2020;41(22):2083-8. doi:10.1093/eurheartj/ehaa409.

14. Altobelli E, Angeletti PM, Marzi F, et al. Impact of SARS-CoV-2 Outbreak on Emergency Department Presentation and Prognosis of Patients with Acute Myocardial Infarction: A Systematic Review and Updated Meta-Analysis. J Clin Med. 2022;11(9):2323. doi:10.3390/jcm11092323.

15. Danilova IA. Morbidity and mortality from COVID-19. Data comparability issue. Demographic review. 2020;7(1):6-26. (In Russ.) doi:10.17323/demreview.v7i1.10818.

16. Lindahl B, Mills NL. A new clinical classification of acute myocardial infarction. Nat Med. 2023;29(9):2200-5. doi:10.1038/s41591-023-02513-2.

17. Hart JD, Sorchik R, Bo KS, et al. Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative. BMC Med. 2020;18(1):74. doi:10.1186/s12916-020-01519-8.

18. Romaguera R, Ribera A, Guell-Viaplana F, et al. Decrease in ST-segment elevation myocardial infarction admissions in Catalonia during the COVID-19 pandemic. Rev Esp Cardiol (Engl Ed). 2020; 73(9):778-80. doi:10.1016/j.rec.2020.06.001.

19. Samorodskaya IV, Bubnova MG, Akulova OA, et al. Indicators of male and female mortality from acute forms of coronary heart disease in five-year age groups in the Russian Federation: what do the figures say? Cardiovascular Therapy and Prevention. 2022;21(12):3460. (In Russ.) doi:10.15829/1728-8800-2022-3460.