Clinical manifestation and impact on management of acute coronary syndrome during covid-19 pandemic, lessons learnt from a tertiary care

Abstract

Funding AcknowledgementsType of funding sources: None.IntroductionThe World Health Organization first characterized COVID-19 as a ongoing pandemic since 12th March 2020. Since then, mitigation plans including vaccinations are on the run globally. During this pandemic several restrictions worldwide are being followed , which had major impact on acute coronary syndrome presentation due to various factors.At our tertiary cardiac care centre we analyzed the consecutive acute coronary syndrome admissions and its impact in the management during the pandemic lockdown .PurposeOur study aimed in identifying the salient clinical manifestations and impact on the management of Acute Coronary Syndrome (ACS) during the 1st wave of COVID-19 Pandemic in a tertiary care center to inform future implications/preparedness for ACS care during the revolving Pandemic.MethodsClinical profile of patients admitted in our tertiary coronary care unit between March – June 2020 was analyzed. Descriptive statistics was performed, and continuous data were reported as mean ± SD and as percentages.ResultsAmong the consecutive 265 patients who were treated in our coronary care unit, mean age of the patients was 58.43 ± 11.366 years and about 81% of them were males. Nearly one third of the patients presented with non-ST elevation MI at the time of diagnosis. Previous history of MI was well pronounced in 63% (N = 169) of the patients with a combined history of hypertension, diabetes, dyslipidemia. A higher proportion of patients presented with mild to moderate left ventricular dysfunction (N = 123, 46.6%). Higher rates of patients needed thrombolysis care (68%) where thrombolysis with ELAXIM (N = 41), STK (N = 22) were commonly used in the process. About 96.2% of the patients presented with delayed window period of >48 hours and about 75% of them underwent ADHOC PCI procedure as the next level of management during admission. Coronary angiogram findings were suggestive of a triple vessel disease in 36% of the patients with previous history of coronary interventions with in the last 5 years. Complications of cardiogenic shock requiring IABP(N = 5). and death were very minimal and were seen in patients with previous coronary bypass surgery with in last 5 years (died, N = 2), acute pulmonary thromboembolism (IABP, N = 2) .ConclusionWe observed patients with late presentation to hospital, covid protocol has increased thrombolysis compared to primary PCI in non covid time with no major bleeding risks in our patients .Most of our patients opted for ADHOC PCI , preexisting coronary artery disease patients presented as triple vessel disease .Though late presentation no significant complication rate noted.Further study would facilitate healthcare planning and preparedness for further COVID waves.