Assessing health system preparedness from trends and time delays in the management of myocardial infarctions during the COVID-19 pandemic in India: a multicentre retrospective cohort study.

Assessing health system preparedness from trends and time delays in the management of myocardial infarctions during the COVID-19 pandemic in India: a multicentre retrospective cohort study.

Publication date: Sep 09, 2025

This study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status. Multicentre retrospective cohort study SETTING: Twenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities. All adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data. Number of MI admissions, median O2D, D2B and D2N times. 30-day outcomes including death, reinfarction and revascularisation. MI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115-428) pre-COVID-19 to 390 min (IQR 165-796) in 2020 and 304 min (IQR 135-780) in 2021. The median D2B time reduced from 225 min (IQR 120-420) in 2019 to 100 min (IQR 53-510) in 2020 and 130 min (IQR 60-704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120-840) to 35 min (IQR 25-69) and 45 min (IQR 24-75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4. 25% in 2020 and 5. 1% in 2021, comparable to 5. 8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study. Despite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.

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Concepts Keywords
Cardiology Adult
Covid Aged
June Cardiovascular Disease
Pandemic COVID-19
COVID-19
Female
Health Services Accessibility
Humans
India
Male
Middle Aged
Myocardial Infarction
Myocardial infarction
Retrospective Studies
SARS-CoV-2
Time-to-Treatment

Semantics

Type Source Name
disease MESH myocardial infarctions
disease MESH COVID-19 pandemic
disease MESH infection
disease MESH death
disease MESH Acute Coronary Syndrome
disease IDO quality
disease IDO country
drug DRUGBANK Coenzyme M
drug DRUGBANK Indoleacetic acid
disease MESH STEMI
disease MESH NSTEMI
disease MESH treatment delays
disease IDO intervention
drug DRUGBANK Azelaic acid
disease IDO symptom
drug DRUGBANK Methionine
drug DRUGBANK Acetohydroxamic acid
disease MESH left bundle branch block
disease MESH chest pain
disease MESH adverse cardiac events
disease MESH emergency
disease MESH hypertension
disease MESH cerebrovascular disease
disease MESH stroke
disease MESH peripheral arterial disease
drug DRUGBANK Ethanol
disease MESH cardiogenic shock
disease MESH heart failure
disease MESH cardiac arrest
disease MESH shock
disease MESH Health Services Accessibility

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