Status of Acute Myocardial Infarction in Southern India During COVID-19 Lockdown: A Multicentric Study

Abstract

There has been a reduction in the reported cases of acute myocardial infarction (MI) across the globe during the outbreak of coronavirus disease 2019 (COVID-19) (severe acute respiratory distress syndrome coronavirus 2). An attempt was made to find out the number of acute MI cases treated during the COVID-19 lockdown period (April 2020) and highlight the possible reasons for the changes in the occurrence. A multicentric retrospective observational study was performed to collect the selected data from 12 private hospitals distributed in 4 citiesdMadurai, Trichy (Thiruchirapalli), Erode, and Salemdof the Tamil Nadu state in southern India. There was a significant (P<.001) reduction in ST-segment elevation MI (STEMI), non-STEMI (NSTEMI), and total (STEMI and NSTEMI together) cases during the lockdown period (April 1 to 30, 2020) as compared with no-lockdown periods such as January and February 2020 and April 2019 and April 2018 in all cities, whereas the reduction was not significant for NSTEMI in Trichy when data for the lockdown period was compared with those for January and February 2020. Overall, there is a reduction in acute MI cases, which may be due to alterations in modifiable risk factors during the COVID-19 lockdown period. Hence, implementation of public education and polices on controlling modifiable risk factors is likely to pay dividends.

Impact of COVID-19 on Acute MI and Percutaneous Coronary Intervention Rates and Outcomes in South East Asia and the Middle East

“…Several centres have reported a decrease in admissions during the pandemic, 1,2,6 whereas others have found no significant difference compared with pre-COVID-19 levels. 5 With regard to the type of MI, most studies have shown a decrease in NSTEMI admissions during the COVID-19 pandemic, but mixed results pertaining to STEMI presentations.…”

“…Beyond an immediate impact on mortality and morbidity, this pandemic has also had secondary ramifications for the provision of healthcare as hospitals change existing workflows to accommodate the screening and treatment of COVID and governments impose lockdown measures that directly and indirectly affect patients' presentation to hospitals.Studies have been published about the effect of the COVID-19 pandemic on procedural volumes of elective percutaneous coronary intervention (PCI), as well as on the presentations and outcomes of acute MI (AMI). [1][2][3][4][5] Many of these studies only capture the perspective of a single centre in a particular country. Furthermore, study findings are mixed, with some studies reporting a decrease in non-ST segment elevation MI (NSTEMI) or ST-elevation MI (STEMI) presentations since the onset of the pandemic, and others finding no significant difference, particularly in the STEMI caseload.…”

“…Furthermore, study findings are mixed, with some studies reporting a decrease in non-ST segment elevation MI (NSTEMI) or ST-elevation MI (STEMI) presentations since the onset of the pandemic, and others finding no significant difference, particularly in the STEMI caseload. [1][2][3][4][5] Similarly, reported effects on door-to-balloon (DTB) time and mortality outcomes are mixed. 1 The aim of this study was to investigate the effects of the COVID-19 pandemic on AMI and PCI rates in countries from Asia and the Middle East to gain an insight into the burden COVID-19 was placing on cardiovascular care.…”

“…Studies have been published about the effect of the COVID-19 pandemic on procedural volumes of elective percutaneous coronary intervention (PCI), as well as on the presentations and outcomes of acute MI (AMI). [1][2][3][4][5] Many of these studies only capture the perspective of a single centre in a particular country. Furthermore, study findings are mixed, with some studies reporting a decrease in non-ST segment elevation MI (NSTEMI) or ST-elevation MI (STEMI) presentations since the onset of the pandemic, and others finding no significant difference, particularly in the STEMI caseload.…”

COVID-19 and the Incidence of Acute Myocardial Injury

“…During the COVID-19 pandemic, several studies reported a decrease in the incidence of hospitalization for acute myocardial infarction worldwide. [43][44][45][46][47][48][49] Among patients with non-ST segment elevation myocardial infarction (NSTEMI) and STEMI, Solomon et al noticed a decline by up to 48% in the weekly rates in March and April 2020 in northern California compared with the same week in 2019. 43 44 The ongoing French Cohort of Myocardial Infarction Evaluation (FRENCHIE) registry, in which 21 centers participated, was recently analyzed by Mesnier et al According to their findings, admissions for acute myocardial infarction decreased by 30% from 686 to 481 between 4 weeks prior to and 4 weeks after the lockdown.…”