<![CDATA[Background: Acute Myocardial Infarction (AMI) and recurrent AMI remain major contributors to cardiovascular morbidity and mortality in Indonesia. However, national data describing trends in hospitalized AMI incidence and recurrent AMI, particularly during the Coronavirus Disease 2019 (COVID-19) pandemic, are limited. Methods: We conducted a population-based analysis using nationally representative Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS Kesehatan, Social Health Insurance Administration Body) claims sample data from 2019 to 2024, excluding 2021 due to incomplete data. Hospitalized AMI incidence and temporal trends were evaluated using a repeated cross-sectional design, whereas recurrent AMI was examined using longitudinal patient-level linkage. AMI episodes were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes (I21–I22). Survey-weighted analyses estimated the incidence of hospitalized AMI, and survey-weighted logistic regression examined factors associated with recurrent AMI. Results: We identified 9,494 AMI episodes among 7,618 unique patients. Hospitalized AMI incidence per 100,000 insured population declined from 58.1 in 2019 to 49.8 in 2020, followed by a sustained increase, reaching 80.5 in 2024 and exceeding pre-pandemic levels. Overall, 13.5% of patients experienced recurrent AMI. Recurrent AMI was independently associated with heart failure (OR 3.72; 95% CI 2.84–4.88), hypertension (OR 3.00; 95% CI 2.27–3.96), diabetes mellitus (OR 1.61; 95% CI 1.19–2.17), and male sex (OR 1.57; 95% CI 1.20–2.05). Older age (≥65 years) was not independently associated with recurrent AMI. Conclusions: Hospitalized AMI incidence in Indonesia rebounded from the early COVID-19 decline and reached its highest level observed in 2024. Recurrent AMI clustered around modifiable cardiometabolic conditions, highlighting critical gaps in secondary prevention. Within a universal health coverage system, recurrent AMI may be a measurable, potentially preventable population-level outcome.]]>
