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. 2021 Jul-Aug;73(4):413-423.
doi: 10.1016/j.ihj.2021.06.003. Epub 2021 Jun 18.

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Geevar Zachariah  1 , Sivasubramanian Ramakrishnan  2 , Mrinal Kanti Das  3 , Abdullakutty Jabir  4 , Pathiyil Balagopalan Jayagopal  5 , Krishnannair Venugopal  6 , Kalaivani Mani  7 , Amal Kumar Khan  8 , Amit Malviya  9 , Anshul Gupta  10 , Ashok Goyal  11 , B P Singh  12 , Bishav Mohan  13 , Bishwa Bhushan Bharti  14 , Biswajit Majumder  15 , Bivin Wilson  16 , Chakkalakkal Prabhakaran Karunadas  17 , Chandra Bhan Meena  18 , Cholenahally Nanjappa Manjunath  19 , Mathew Cibu  17 , Debabrata Roy  20 , Dinesh Choudhary  21 , Dipak Ranjan Das  22 , Dipak Sarma  23 , Meennahalli Palleda Girish  24 , Gurpreet Singh Wander  13 , Harsh Wardhan  25 , Janakiraman Ezhilan  26 , Karthik Tummala  27 , Virender Kumar Katyal  28 , Kewal Goswami  29 , Kodangala Subramanyam  30 , Krishna Kishore Goyal  31 , Kenchappa Kumar  32 , Lekha Adik Pathak  33 , Manish Bansal  34 , Manoranjan Mandal  35 , Mohit Dayal Gupta  24 , Narendra Nath Khanna  36 , Natesh Bangalore Hanumanthappa  37 , Neil Bardoloi  38 , Nitin Modi  39 , Nitish Naik  29 , Pradeep K Hasija  40 , Prafulla Kerkar  41 , Pranab Jyoti Bhattacharyya  42 , Pushkraj Gadkari  43 , Rabindra Nath Chakraborthy  44 , Rahul Raosaheb Patil  45 , Rakesh Gupta  46 , Rakesh Yadav  29 , Rambhatla Suryanarayana Murty  47 , Ranjit Kumar Nath  48 , Rathinavel Sivakumar  49 , Rishi Sethi  50 , Rituparna Baruah  51 , Sanjay Tyagi  24 , Santanu Guha  52 , Santhosh Krishnappa  53 , Satish Kumar  54 , Satya Narayan Routray  55 , Satyendra Tewari  56 , Saumitra Ray  57 , Seemala Saikrishna Reddy  29 , Sharad Chandra  50 , Shashi Bhushan Gupta  58 , Shashi Shekhar Chatterjee  59 , K K H Siddiqui  60 , Maduramuthu Sivabalan  61 , Sreekanth Yerram  62 , Sudeep Kumar  56 , Swaminathan Nagarajan  63 , Tom Devasia  64 , Uday Jadhav  65 , Varun Shankar Narain  50 , Vijay Kumar Garg  66 , Vitull K Gupta  67 , Dorairaj Prabhakaran  68 , Pradip Kumar Deb  69 , Padinhare Purayil Mohanan  70 ; CSI-AMI Study group
Affiliations

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Geevar Zachariah et al. Indian Heart J. 2021 Jul-Aug.

Abstract

Aim: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India.

Methods & results: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively.

Conclusions: The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

Keywords: Acute coronary syndrome; Acute myocardial infarction (AMI); COVID-19 pandemic; LMIC; Low-and middle-income country; Non ST elevation Myocardial infarction (NSTEMI) and outcome; ST elevation Myocardial infarction (STEMI).

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Conflict of interest statement

Declaration of competing interest Nothing to declare for all the authors.

Figures

Fig. 1
Fig. 1
Decrease in MI admissions across various zones of India in 2020 as compared to 2019 with 99% CI.
Fig. 2
Fig. 2
A. Weekly trends in MI admissions per state as compared to cumulative COVID-19 cases in India.B. Weekly trends in MI admissions per state as compared to stringency of lockdown index.C. Correlation between weekly decrease in MI admissions in 2020 and new COVID-19 cases in India. D. Correlation between weekly decrease in MI admissions in 2020 and stringency of lockdown index. E. Weekly STEMI admissions as compared to new COVID-19 cases. F. Weekly trends in MI mortality as compared to Government response index.
Fig. 2
Fig. 2
A. Weekly trends in MI admissions per state as compared to cumulative COVID-19 cases in India.B. Weekly trends in MI admissions per state as compared to stringency of lockdown index.C. Correlation between weekly decrease in MI admissions in 2020 and new COVID-19 cases in India. D. Correlation between weekly decrease in MI admissions in 2020 and stringency of lockdown index. E. Weekly STEMI admissions as compared to new COVID-19 cases. F. Weekly trends in MI mortality as compared to Government response index.
Fig. 3
Fig. 3
Multi-level logit model with patient and hospital level variables characterizing MI admissions in 2020 in comparison to 2019.
See this image and copyright information in PMC

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