Response To: Correspondence on ‘cardiovascular Disease and Mortality Sequelae of COVID-19 in the UK Biobank’ by Jolobe

To the Editor No evaluation of cardiovascular disease and mortality sequelae of COVID19 would be complete without documentation of the increase in the prevalence of mechanical complications (MCs) of myocardial infarction (MI) attributable to delay in seeking or obtaining timely reperfusion treatment for ST elevation myocardial infarction (STEMI). This delay was associated with a resurgence of STEMIrelated MCs, namely, ventricularfree wall rupture, acute papillary muscle rupture with mitral regurgitation and ventricular septal rupture, which had hitherto undergone a significant decrease in prevalence. In Taiwan, Lin et al noted that among 1523 adult cardiac operations performed in two hospitals over a period of 5 years (January 2015 to December 2019), only 0.3% (95% CI 0.1% to 0.5%) of the patients were diagnosed with MCs of MI. However, within the first 5 months of 2020 (the COVID19 pandemic era), MIrelated MCs underwent an increase in prevalence amounting to 4.2% of 118 cardiac operations. In France, Bouisset et al studied the impact of delay in seeking medical attention (the socalled prehospital delay) on the prevalence of MCs of STEMI. Data on 6185 patients were evaluated in an analysis that covered two time periods, namely, 1 March 2019 to 31 May 2019 and 1 March 2020 to 31 May 2020. In that analysis, patients were allocated to four groups according to prehospital delay, as follows: 0–12 hours, 12–24 hours, 24–36 hours and 36–48 hours. In the four subgroups, global rates of MCs were 0.82%, 1.43%, 1.24% and 5.07%, respectively. The global rate of MC significantly (p<0.001) increased with prehospital delay. Lin et al attributed the prehospital delay to fear of contracting COVID19 infection. This was a fear also expressed by a number of patients in a narrative review of the association of COVID19 and STEMIrelated ventricular septal rupture.