Sunita Arun BoradeRuby Hall Clinic, India
Title: Clinical study of patients presenting with st elevation myocardial infarction(stemi) during period of covid pandemic
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 where time is essence. 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: It is a single-center, prospective, observational study, conducted in patients of age > 18 years, either gender, with clinical presentation suggestive of acute myocardial infarction.
Results: Total 145 patients were studied, from the 51-60 years age group (40%) followed by > 60 years age group (30.3%). Male patients (82.8%) outnumbered female patients (17.2%) ..
RT PCR report was suggestive of COVID POSITIVE in 17 patients (11.72%). Symptoms were chest pain
(80%), breathlessness (44.14%), sweating (39.31%) and palpitation (34.48%). 66 patients presented with a 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 the present study, Anterior Wall MI (61.38%), Inferior Wall MI (22.07%) and Inferior posterior MI (8.97%) were noted. 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 arrhythmias (VT, VF) (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.
Dr.Sunita Arun Borade completed MD (Medicine) in 1989 from Dr. V M Medical College, Solapur under Shivaji University, Kolhapur , Maharashtra ,India . Joined Ruby Hall Clinic, Pune in 1992 in the Critical Care Department . Joined Cardiac ICU in 1999 . At present working as a Senior Consultant in Cardiac ICU and has become an International Associate Member of American College of Cardiology in 2013.