Clinical study of patients presenting with ST elevation myocardial infarction (STEMI) during period of COVID pandemic

 

 

Abstract              Background: Covid pandemic has an unintentional effect on the management of ACS (acute coronary syndrome) and in particular STEMI (ST-elevation myocardial infarction), and high-risk NSTEMI (non ST-elevation myocardial infarction) where time is the most important determinant of the outcome. Present clinical study was aimed to study patients presenting with ST elevation myocardial infarction during period of COVID pandemic, at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in patients of age > 18 years, either gender, with clinical presentation suggestive of acute myocardial infarction. Results: In present study 145 patients were studied. Majority of them were from 51-60 years age group (40%) followed by > 60 years age group (30.3%). Male patients (82.8%) outnumbered female patients (17.2%) and male to female ratio was 4.8:1. RTPCR report was suggestive of COVID POSITIVE in 17 patients (11.72%). Symptoms observed in majority of patients were chest pain (80%), breathlessness (44.14%), sweating (39.31%) and palpitation (34.48%). 66 patients presented with classical symptom triad of MI (chest pain, breathlessness, sweating). Majority of patients were seen at 4- 8 hours from onset of symptoms (29.66%), followed by at 1- 4 hours from onset of symptoms (20.69%). LVEF > 35% was noted in 53.79% patients. In present study, Anterior Wall MI (61.38%), Inferior Wall MI (22.07%) and Inferior posterior MI (8.97%) were most common types noted. In present study we thrombolysed 103 patients (71.03%). Majority with streptokinase (43.45%) followed by Tenecteplase (24.83%) and Reteplase (2.76%). 35 patients were thrombolysed within 30 minutes. Door to needle time was less than 1 hour in 63.45% patients. Primary PTCA was done in 7 patients. Door to balloon time was < 1 hour and 1-2 hours in 42.85% patients. We used GPIIbIIIa inhibitors in 34.48% patients. (tirofiban- 33.10% and eptifibatide- 1.38%). In present study PTCA was DONE in 101 patients (69.66%). Common findings were single vessel PTCA (34.48%), Multivessel (26.90%), LAD (18.62%), RCA (8.97%), LCX (5.52%). In the present study, common complications noted were heart failure (34.48%), cardiogenic shock (21.38%), malignant arrythmias (VT, V F) (15.17%) and MR (3.45 4 deaths were noted during hospital stay. Majority of patients were discharged in 2-4 days (71.72%). Conclusion: In COVID pandemic, STEMI patients had longer total ischemic time, leading to a more severe disease status on hospital admission, as well as a higher rate of in-hospital adverse events was noted.

Keywords: COVID pandemic, STEMI, hospital admission, acute myocardial infarction.