Clinical, angiographic profile and immediate outcome of COVID-19 patients presenting as acute coronary syndrome: An observational study

Background: COVID 19 pandemic has involved around 213 countries and affected around 33 million people worldwide and around 6.2 million in India with about 1 million deaths worldwide. Lockdown was enforced in India as in other parts of the world to contain the spread of COVID 19 pandemic. However, it resulted in decreased hospitalization for acute coronary syndrome, delayed presentation and change in decision making. The main aim of our study was to analyse the presenting pattern and outcome of COVID-19 patients. Materials and Methods: In our study, done at tertiary care centre, patients of acute coronary syndrome over last 4 months underwent RT-PCR for SARS CoV-2 and HRCT chest prior to admission. A total of 25 (5.8 %) patients with acute coronary syndrome who had evidence of COVID 19 infection were enrolled in the study. This group was evaluated for the risk factors, presenting symptoms, killip class, type of acute coronary syndrome (STEMI vs NSTEMI), time to presentation to hospital, treatment received (medical management/thrombolysis/PCI/CABG), cardiac arrhythmias, mean ejection fraction, HRCT chest (CORADS grading), any complications and immediate outcome. Results: In our study group, mean age of presentation was 50.9 + 12.8 years involving predominantly males (72%). Hypertension was present in 11(44%), diabetes in 7 (28%), smoking in 8 (32%) and obesity in 5 (20%) patients respectively. The main presenting symptom was only chest pain in 20 (80 %) patients followed by chest pain and dysnea in 4 (16 %) patients. Fever was present at the time of presentation in only 8 (32 %) patients. Most common presentation was STEMI (84%). Only 5 patients (23.8 %) in the STEMI group presented to the hospital within the window period. Around 60 % patients presented with killip class I, 4 patients had cardiac arrhythmias (first degree heart block, 2:1 AV block, atrial fibrillation and ventricular tachycardia). Mean ejection fraction of our study group was 40.6 + 8.9. Most common finding on HRCT chest was CORADS 5 (40%) followed by CORADS 4 (24%). Coronary angiogram was done in 4 (16%) patients who had persistent chest pain and intervention was attempted/done in 3 of these patients. Around 7 (28 %) patients had complications which included acute kidney injury in one patient, multiorgan dysfunction (MODS) in three patients out of which two patients died, ischemic hepatitis in one patient, lower limb DVT in 1 patient and DVT with pulmonary thromboembolism in one patient. Both the expired patients belonged to the nonintervention arm. Conclusion: In our study, 5.8 percent patients of acute coronary syndrome had evidence of COVID 19 infection. Most of these patients had delayed presentation to the hospital, a less of interventional strategy and more of conservative management was instituted. Intervention was done/attempted in 4 patients who had persistent chest pain. Complications developed in 24 % of the patients with a mortality of 8 %. The expired patients belonged to the nonintervention arm and had multiorgan dysfunction.