ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1540783
Observed and expected overall mortality for acute myocardial infarction during the COVID-19 pandemic in Italy: An analysis of nationwide institutional databases
Provisionally accepted
Leonardo De Luca1*
Francesco Grippo2
Paola D'Errigo3
Alessandra Burgio2Stefano Rosato3Barbara Giordani4Giorgia Duranti4Giovanni Baglio4- 1San Matteo Hospital Foundation (IRCCS), Pavia, Lombardy, Italy
- 2Italian National Institute of Statistics (ISTAT), Rome, Lazio, Italy
- 3Istituto Superiore di Sanità, Roma, Italy
- 4National Agency for Regional Healthcare Services (AGENAS), Rome, Lazio, Italy
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Aim-To carry out a nationwide evaluation of both in-and out-of-hospital mortality for acute myocardial infarction (AMI) during the COVID-19 pandemic period in Italy.-This was a retrospective cohort study analysing overall mortality for AMI in Italy during the COVID-19 pandemic (March 1 st , 2020 to December 31 st , 2021) and the previous 5 years (January 1 st , 2015 to February 29 th , 2020). To carefully analyze both in-and out-of-hospital mortality for AMI (with or without concomitant COVID-19 infection) we used different institutional administrative sources of national data. Excess mortality related to AMI during the COVID-19 pandemic has been analyzed using the observed/expected ratio (OER).Results-Over the 5 years pre-pandemic period, 150,299 fatal events related to AMI occurred.During the pandemic, the number of deaths related to AMI was 28,673 in 2020 and declined to 26,688 in 2021. The overall OER was 1.18 [95% confidence intervals (CI): 1.15-1.22] in 2020 and 1.19 (95% CI: 1.15-1.22) while out-of-hospital OER was 1.24 (95% CI: 1.20-1.29) in 2020 and 1.21 (95% CI: 1.16-1.25) during the pandemic. When excluding COVID-19 related deaths, the number of observed in-hospital deaths did not significantly differ from the expected both in 2020 and 2021 while the excess remains unchanged for out-of-hospital mortality.Conclusions-In this analysis of nationwide institutional administrative databases, we documented an increase in observed mortality compared to the expected during the COVID-19 pandemic in Italy. This mortality increase is mainly attributable to out-of-hospital fatal events and related to concomitant COVID-19 infection for hospitalized AMI patients.
Keywords: 3119, 24 references, 2 Tables, 3 Figures, 1 Suppl Table acute myocardial infarction, COVID-19 infection, Mortality, Administrative database, cohort study
Received: 06 Dec 2024; Accepted: 15 May 2025.
Copyright: © 2025 De Luca, Grippo, D'Errigo, Burgio, Rosato, Giordani, Duranti and Baglio. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Leonardo De Luca, San Matteo Hospital Foundation (IRCCS), Pavia, 27100, Lombardy, Italy
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