Key result
COVID-19 lockdowns in India linked to ~52% fewer MI admissions alongside prolonged presentation delays.
Why the study?
To examine MI care trends, treatment time intervals, and clinical outcomes in India during the COVID-19 lockdown periods compared with the pre-pandemic period.
Did the COVID-19 lockdown periods in 2020 and 2021 impact acute myocardial infarction hospital admissions, critical treatment delay intervals (O2D, D2B, D2N), and 30-day clinical outcomes compared to the 2019 pre-pandemic period in India?
Cohort (n=3,614)
Yes
Did the COVID-19 lockdown periods in 2020 and 2021 impact acute myocardial infarction hospital admissions, critical treatment delay intervals (O2D, D2B, D2N), and 30-day clinical outcomes compared to the 2019 pre-pandemic period in India?
During the 2020 and 2021 COVID-19 lockdowns in India, acute MI hospital admissions dropped by more than half and pre-hospital onset-to-door delays increased substantially, highlighting systemic pre-hospital barriers and ambulance infrastructure gaps in acute cardiovascular care.
Answers are grounded in this paper and cite their sources.
Lockdowns linked to fewer MI admissions and longer delays signal care avoidance risks; leaves open true incidence vs access effects for future crises.
OBJECTIVES: 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. DESIGN: Multicentre retrospective cohort study SETTING: Twenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities. PARTICIPANTS: 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. PRIMARY OUTCOMES: Number of MI admissions, median O2D, D2B and D2N times. SECONDARY OUTCOMES: 30-day outcomes including death, reinfarction and revascularisation. RESULTS: 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. CONCLUSION: 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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Menon et al. (2025) conducted a cohort in Acute myocardial infarction (STEMI and NSTEMI) (n=3,614). COVID-19 pandemic lockdown periods (March 15 to June 15 in 2020 and 2021) vs. Pre-pandemic baseline period (March 15 to June 15, 2019) and ACS-QUIK reference cohort was evaluated on Number of acute myocardial infarction admissions and median treatment intervals: onset-to-door (O2D), door-to-balloon (D2B), and door-to-needle (D2N) times. COVID-19 lockdowns in India reduced MI admissions by 52.3% in 2020 (2,131 vs 4,470 in 2019) and 66.8% in 2021 (1,483), while median onset-to-door time rose from 200 to 390 and 304 minutes.
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