{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:28:44Z","timestamp":1762918124563,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T00:00:00Z","timestamp":1595289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reports from countries severely hit by the COVID\u201019 pandemic suggest a decline in acute coronary syndrome (ACS)\u2010related hospitalizations. The generalizability of this observation on ACS admissions and possible related causes in countries with low COVID\u201019 incidence are not known.<\/jats:p><\/jats:sec><jats:sec><jats:title>Hypothesis<\/jats:title><jats:p>ACS admissions were reduced in a country spared by COVID\u201019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a nationwide study on the incidence rates of ACS\u2010related admissions during a 6\u2010week period of the COVID\u201019 outbreak and the corresponding control period in 2019 in Greece, a country with strict social measures, low COVID\u201019 incidence, and no excess in mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>ACS admissions in the COVID\u201019 (n = 771) compared with the control (n = 1077) period were reduced overall (incidence rate ratio [IRR]: 0.72, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001) and for each ACS type (ST\u2010segment elevation myocardial infarction [STEMI]: IRR: 0.76, <jats:italic>P<\/jats:italic> = .001; non\u2010STEMI: IRR: 0.74, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001; and unstable angina [UA]: IRR: 0.63, <jats:italic>P<\/jats:italic> = .002). The decrease in STEMI admissions was stable throughout the COVID\u201019 period (temporal correlation; R<jats:sup>2<\/jats:sup> = 0.11, <jats:italic>P<\/jats:italic> = .53), whereas there was a gradual decline in non\u2010STEMI\/UA admissions (R<jats:sup>2<\/jats:sup> = 0.75, <jats:italic>P<\/jats:italic> = .026) following the progressively stricter social measures. During the COVID\u201019 period, patients admitted with ACS presented more frequently with left ventricular systolic impairment (22.2 vs 15.5% control period; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We observed a reduction in ACS hospitalizations during the COVID\u201019 outbreak in a country with strict social measures, low community transmission, and no excess in mortality. Medical care avoidance behavior is an important factor for these observations, while a true reduction of the ACS incidence due to self\u2010isolation\/quarantining may have also played a role.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.23424","type":"journal-article","created":{"date-parts":[[2020,7,21]],"date-time":"2020-07-21T09:42:08Z","timestamp":1595324528000},"page":"1142-1149","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["\u201cMissing\u201d acute coronary syndrome hospitalizations during the <scp>COVID<\/scp>\u201019 era in Greece: Medical care avoidance combined with a true reduction in incidence?"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5646-0378","authenticated-orcid":false,"given":"Michail I.","family":"Papafaklis","sequence":"first","affiliation":[{"name":"2nd Department of Cardiology University Hospital of Ioannina  Ioannina Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christos S.","family":"Katsouras","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology University Hospital of Ioannina  Ioannina Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grigorios","family":"Tsigkas","sequence":"additional","affiliation":[{"name":"Department of Cardiology Patras University Hospital  Patras Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Toutouzas","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology \u201cHippokration\u201d University Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Periklis","family":"Davlouros","sequence":"additional","affiliation":[{"name":"Department of Cardiology Patras University Hospital  Patras Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George N.","family":"Hahalis","sequence":"additional","affiliation":[{"name":"Department of Cardiology Patras University Hospital  Patras Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria S.","family":"Kousta","sequence":"additional","affiliation":[{"name":"Cardiology Department General Hospital \u201cG. Gennimatas\u201d  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis G.","family":"Styliadis","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology \u201cPapageorgiou\u201d General Hospital  Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Triantafyllou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology \u201cEvaggelismos\u201d General Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loukas","family":"Pappas","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology \u201cEvaggelismos\u201d General Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fotini","family":"Tsiourantani","sequence":"additional","affiliation":[{"name":"2nd Department of Cardiology Hellenic Red Cross Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Efthymia","family":"Varytimiadi","sequence":"additional","affiliation":[{"name":"Department of Cardiology \u201cAttikon\u201d University Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zacharias\u2010Alexandros","family":"Anyfantakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital of Larissa  Larissa Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Iakovis","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital of Larissa  Larissa Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paraskevi","family":"Grammata","sequence":"additional","affiliation":[{"name":"Department of Cardiology \u201cSismanogleio\u201d General Hospital  Athens Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haralambos","family":"Karvounis","sequence":"additional","affiliation":[{"name":"Department of Cardiology \u201cAHEPA\u201d University Hospital  Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonios","family":"Ziakas","sequence":"additional","affiliation":[{"name":"Department of Cardiology \u201cAHEPA\u201d University Hospital  Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Sianos","sequence":"additional","affiliation":[{"name":"Department of Cardiology \u201cAHEPA\u201d University Hospital  Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Tziakas","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Hospital of Alexandroupolis  Thrace Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evgenia","family":"Pappa","sequence":"additional","affiliation":[{"name":"Department of Cardiology General Hospital \u201cG. 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European mortality monitoring activity.https:\/\/euromomo.eu\/graphs-and-maps.2020."},{"key":"e_1_2_8_8_1","unstructured":"National Public Health Organization. Daily report on epidemiological surveillance for new coronavirus disease (COVID\u201019).https:\/\/eody.gov.gr\/wp-content\/uploads\/2020\/04\/covid-gr-daily-report-20200413-1.pdfAccessed April 13 2020(In Greek)."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa409"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.006631"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2020.04.022"},{"key":"e_1_2_8_12_1","article-title":"Acute coronary syndromes undergoing percutaneous coronary intervention in the COVID\u201019 era: comparable case volumes but delayed symptom onset to hospital presentation","volume":"7","author":"Toner L","year":"2020","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)62296-9"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1702090"},{"key":"e_1_2_8_15_1","unstructured":"Flu News Europe. 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