EuroPCR 2020 | Sudden Death Increase Two to Three Times While MI Rate Falls

The number of sudden deaths reported around the world is on the rise in Covid-19 times. These deaths are caused either by the virus and its capacity to produce lethal arrhythmias or by the fact that patients are staying away from hospitals and are not being examined. 

Cardiologists were the first to warn that the sudden drop in ACS cases would have negative consequences in the short term, such as late presentation with already deteriorated ventricular function, increased mechanical complications, and increased sudden death. 

The Italian have reported a 58% increase in sudden death at home during Covid peak in the Lombardy region vs. the same period last year. 

Recently, Italian authors have also presented in the European Heart Journal and the virtual EuroPCR a 52% increase in sudden death out of hospital. 

But this time the curve of sudden death out of hospital every 100,000 inhabitants show strong statistic correlation with Covid-19 patients every 100,000 inhabitants.

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Simultaneously, French authors have provided similar information (published in The Lancet): the incidence of sudden death has doubled, and it matches the peak of Covid-19.

In New York (another great epicenter) the same story repeats. After a study published in JAMA, the number of calls to the emergency room for sudden deaths tripled (47.5 vs 15.9 every 100,000 inhabitants) during the peak. The ER was not able to save many of them and mortality went over 90%.

The discussion now revolves around the question of whether these MI patients died because they would not see a doctor in time or because of Covid-19 infection. In New York there are no data on the deceased, but in Paris, approximately one third of the cohort was either confirmed or suspected of infection. 

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Wildly speculating, we could say up to 70% of sudden death cases in 2020 vs. the same period in 2019 could have been caused by Covid-19, driven by respiratory failure, myocardial injury or pulmonary embolism or prolonged QT (be it inflammatory or drug induced, such as hydroxychloroquine). 

The rest might also have been caused by Covid-19, but only indirectly. This is the case of CAD patients with clear symptoms that would not see a doctor because of fear of catching the disease. 

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Original Title: COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study. Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City.

Reference: Baldi E et al. Eur Heart J. 2020; Epub ahead of print. Marijon E et al. Lancet Public Health. 2020; Epub ahead of print. Lai PH et al. JAMA Cardiol. 2020; Epub ahead of print.

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