Excess mortality for acute myocardial infarction in the United States during the first two years of the COVID-19 pandemic

Our analysis of the CDC WONDER online database shows that the mortality rate for AMI increased significantly in the first two years of the COVID-19 pandemic.This consistent trend across the two analyses may have several causes, the first of which is certainly the impact of SARS-CoV-2 on the myocardial tissue, as it is now clearly recognized that patients with COVID-19 have an increased risk of developing myocardial ischemia. Difficult access to emergency care for patients with acute episodes of myocardial ischemia is another possible explanation, as emergency departments were overcrowded with COVID-19 patients requiring respiratory and/or systemic support, especially during the first two years of the pandemic, which was characterized by higher virulence of SARS-CoV-2 and the absence of vaccine-induced immunity. Periods of social restrictions, especially in the early period of the pandemic, may have exacerbated the effects of some important risk factors for myocardial ischemia (e.g., low physical activity, stress, unhealthy diet, and so forth). Finally, the negative impact of SARS-CoV-2 infection on patients with pre-existent pathologies, including coronary artery disease, may have contributed to an increase in the risk of developing acute episodes of myocardial ischemia.