Related Experiment Video
Updated: Jul 25, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Variations and Associated Factors in Symptom-to-Balloon (STB) Time and Door-to-Balloon (DTB) Time Before and After
Neeraj V Mohandas1, Vijayakumar K2, Aswathy Sreedevi3
1Community Medicine, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, IND.
Insights
COVID-19 lockdown did not significantly alter symptom-to-balloon or door-to-balloon times for acute myocardial infarction patients in India. However, delays in symptom recognition persist, highlighting the need for public awareness of non-communicable disease symptoms.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic and subsequent lockdowns significantly impacted healthcare access and patient mobility.
- Timely interventions, measured by symptom-to-balloon (STB) and door-to-balloon (DTB) times, are critical for acute myocardial infarction (MI) management.
- Understanding the effect of the lockdown on these critical time intervals is essential for maintaining cardiovascular care standards.
Purpose of the Study:
- To evaluate changes in STB and DTB times for acute MI patients before and after the COVID-19 lockdown in Southern India.
- To identify risk factors associated with variations in STB and DTB times during the lockdown period.
- To assess the overall efficiency of the healthcare system in managing MI during restricted movement.
Main Methods:
- A cross-sectional study analyzed data from 105 acute MI patients admitted to two tertiary care centers over six months.
- STB and DTB times were compared for periods before (pre-March 2020) and after (post-March 2020) the COVID-19 lockdown.
- Statistical analyses included Chi-square, Mann-Whitney U tests, and regression to identify significant predictors (p<0.05).
Main Results:
- Overall mean STB time was 408.7 minutes and mean DTB time was 161.7 minutes.
- No statistically significant variation in STB or DTB times was observed between pre- and post-lockdown periods.
- Patients over 60 years showed a significant association with longer STB times post-lockdown (p=0.040); referrals from primary/secondary care reduced DTB time (AOR=4.669).
Conclusions:
- The healthcare system demonstrated resilience in managing acute MI during the lockdown, with no significant delays in reperfusion times.
- A delay in symptom recognition for MI was perceived, underscoring the need for public education on NCD symptoms.
- Emphasizing the importance of time-sensitive interventions for conditions like MI and stroke is crucial for the general population.
Introduction:
During the COVID-19 lockdown, India saw a major restriction in the movement of people. Patients with acute myocardial infarction (MI) required early interventions and follow-up of independent predictors like symptom-to-balloon (STB) time and door-to-balloon (DTB) time. This study aimed to determine changes in STB and DTB time before and after the COVID-19 lockdown and its associated risk factors.
Methods:
A hospital-based cross-sectional study of 105 patients admitted to the cardiac care units (CCU) of two tertiary care centers in a district of Southern India for six months was conducted to compare the changes in STB and DTB time before and after the COVID-19 lockdown (three months before March 2020 and three months after March 2020), and data was collected from medical records. The data collected was then entered into Microsoft Excel (Microsoft Corporation, Washington, USA), numerically coded, and analyzed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). The Chi-square and Mann-Whitney U tests assessed the association between the dependent and independent variables. The STB/DTB time (before and after the COVID-19 lockdown) was the dependent variable, while the age, gender, co-morbidities, smoking status, and date of admission of patients (before and after the COVID-19 lockdown) were taken as the independent variables. A p-value of <0.05 was considered statistically significant. The predictor variables were identified using the regression method, where all variables with a significance of <0.2 were taken.
Results:
The overall mean (±SD) STB time was 408.7 (±307.1) minutes, and the mean (±SD) DTB time was 161.7 (±261.6) minutes. The pre-lockdown mean STB time was 404.6 minutes, and the mean DTB time was 153 minutes, whereas the post-lockdown mean STB and DTB time were higher at 413.3 minutes and 171.6 minutes, respectively. Out of the total 105 patients, 95 (90.5%) had an STB time of ≥120 minutes, and 77 (73.3%) had an ideal DTB time of <90 minutes. There was no statistically significant variation in the STB and DTB time before and after the lockdown. Only the age group >60 years (38 (97.4%)) was found to be statistically significant with an STB time of ≥120 minutes after the lockdown (p-value=0.040), and patients referred from primary and secondary care centers (AOR (95% CI)=4.669 (1.129-19.298)) were found to be an independent factor in reducing DTB time before and after the COVID-19 lockdown.
Conclusion:
The efficiency of the health system, irrespective of the COVID-19 lockdown, was observed; nevertheless, a delay in the overall recognition of symptoms of MI was perceived. The importance of time factors in identifying the symptoms of non-communicable diseases (NCDs), especially MI and stroke, has to be ascertained among the general population.
More Related Videos
15:00Setup of Consumer Wearable Devices for Exposure and Health Monitoring in Population Studies
Published on: February 3, 2023
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:25Transmission-based Precautions II: Airborne and Protective Environment
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
01:17Transmission-based Precautions I: Contact, Enteric, and Droplets
Contact Precautions:
Contact precautions are the measures taken to prevent the transmission of infectious agents, especially epidemiologically important microorganisms such as MRSA or influenza, primarily transmitted through direct or indirect contact with an...
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the progression...
01:23Investigation of Disease Outbreaks