从印度新冠疫情期间心肌梗死管理的趋势和时间延迟评估卫生系统的准备情况：一项多中心回顾性队列研究
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.
作者信息
Menon Jaideep C, Ms Aravind, S Harikrishnan, Janakiram Chandrashekar, James Anju, Sreedevi Aswathy, Menon Geetha R, John Denny, Cherian Jerin Jose, V Vanajakshamma, Abhaichand Rajpal K, Punnoose Eapen P, Bs Arun, Abraham Mathew, Thomas Paul, Pedada Chakradhar, Govindan Unni, Mohan Bishav, Pisharody Sunil, Devasia Tom, Sebastian Placid, Thachathodiyl Rajesh, G Vijayaraghavan, Arora Nitesh, Hegde Anupama V, Joseph Johny, John John F, Negi Prakash Chand, Mantri Raja Ram, Malviya Amit, Cd Ramakrishna, Vijan Vikrant
机构信息
Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
出版信息
BMJ Open. 2025 Sep 9;15(9):e094109. doi: 10.1136/bmjopen-2024-094109.
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.
目的
本研究旨在分析2020年和2021年新冠疫情封锁期间（3月15日至6月15日）心肌梗死（MI）的住院人数，并与2019年疫情前的相应时期进行比较。该研究还评估了关键治疗间隔的变化：发病至入院（O2D）、入院至球囊扩张（D2B）和入院至穿刺（D2N），并评估了30天的临床结局。本研究调查了新冠疫情封锁期间印度的MI护理趋势，无论患者的新冠病毒感染状况如何。
设计
多中心回顾性队列研究
地点
印度多个邦的23家公立和私立医院，均具备全天候介入心脏病学设施。
参与者
2019年（疫情前）、2020年（首次封锁）和2021年（第二次封锁）3月15日至6月15日期间因急性心肌梗死入院的所有成年人（>18岁）。排除重复和不完整数据后，共分析了3614例病例。
主要结局
MI住院人数、O2D、D2B和D2N时间的中位数。
次要结局
30天结局，包括死亡、再梗死和血运重建。
结果
MI住院人数从2019年的4470例降至2020年的2,131例和2021年的1,483例。O2D时间的中位数从新冠疫情前的200分钟（四分位间距115 - 428）增加到2020年的390分钟（四分位间距165 - 796）和2021年的304分钟（四分位间距135 - 780）。D2B时间的中位数从2019年的225分钟（四分位间距120 - 420）降至2020年的100分钟（四分位间距53 - 510）和2021年的130分钟（四分位间距60 - 704）。同样，D2N时间分别从240分钟（四分位间距120 - 840）降至35分钟（四分位间距25 - 69）和45分钟（四分位间距24 - 75）。2020年死亡、再梗死和血运重建的30天结局为4.25%，2021年为5.1%，与喀拉拉邦急性冠状动脉综合征质量改善研究报告的5.8%相当。
结论
尽管印度各地的导管插入设施有所增加，但该国在实现最佳MI护理的国际基准方面仍有差距。
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