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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; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 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.

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

BACKGROUNDCoronary angiography (CAG) is the most common procedure done in a cardiac catheterization lab (cathlab). In the last decade, the preferred access has changed to radial from femoral artery. CAG via radial route is believed to have a long learning curve. We wanted to assess the success rate of right radial route for CAG and its improvement over one year for operators inexperienced with the radial route. METHODSA retrospective study over one-year period from June 1, 2017 to 31 May 2018 involving 1011 CAGs was done. First 150 CAGs were compared with 150 CAGs done at end of first year. Demographic variables of patients, arterial access for CAG, fluoroscopy time, number of cine angios recorded and radiation dose of cinerecording were compared. Qualitative data was analysed using Chi Square test, quantitative data using independent t test and correlation done using Pearson correlation. RESULTSDemographic variables were comparable between the two groups. CAG was completed successfully in 88.7% (133/150) via right radial artery in first group and in 92.7% (139/150) in second group (p<0.05). There was significant reduction of 1.8 minutes in mean fluoroscopy time between the two groups (6.5 vs. 4.7 minutes p<0.001). A positive correlation was noted between total radiation dose and number of cine films recorded in both groups. CONCLUSIONSCAG via right radial route can be done with good success rate even by inexperienced operators. The success rate improves, and fluoroscopic time decreases over time. By reducing the number of cine recordings total radiation dose can be brought down.

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