THE IMPACT OF 2YEARS OF THE COVID-19 PANDEMIC ON MYOCARDIAL INFARCTION HOSPITALIZATION AND MORTALITY; SEX AND AGE DIFFERENCES

Abstract
Background
Previously, we observed a decline in hospital admissions for stroke unrelated to COVID-19 intensity. Many countries also reported reduced myocardial infarction (MI) admissions during the pandemic without clear explanation. This nationwide study spanning two COVID-19 years aims to analyze whether this reduction is linked to pandemic intensity, lockdown measures, and assess sex and age differences.
Methods
Comparing the first (March 1, 2020, to February 28, 2021) and second (March 1, 2021, to February 28, 2022) pandemic years with the preceding year (March 1, 2019, to February 28, 2020), we utilized data from the National Register of Reimbursed Health Services for MI volumes and patient characteristics. Mortality data were extracted from the Czech National Mortality Registry, covering all hospitalizations and deaths in the Czech Republic.
Results
During the first and second pandemic year , MI admissions declined by 10.6% (p<0.001) and 8.9% (p<0.001) compared to the preceding year, totalling 13,856 and 14,123 versus 15,499 admissions, respectively.
Significant decline appeared in all COVID-19 waves, with the most substantial reduction (-16%) during the first strict national lockdown in spring 2020 despite the lowest COVID-19 incidence. The decline was more pronounced in women aged 70 years or older during both pandemic years. 
Conclusions
The decline in MI admissions during the COVID-19 pandemic was unrelated to COVID-19 incidence, with the most significant reduction during the first COVID-19 wave and lockdown despite the lowest COVID-19 incidence. Notably, this decrease primarily affected older women, emphasizing potential sex differences in the health impact of the pandemic. Future research will clarify whether this reduction in MI admissions contributes to increased out-of-hospital cardiovascular deaths or long-term complications.