Admissions and management strategies for acute coronary syndromes during COVID-19

Abstract

Background and Objectives: Severe respiratory syndrome caused by coronavirus 2 (SARS COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 12, 2020. In India, the central government declared lockdown on March 25, 2020. We report the trends in admissions for acute coronary syndromes (ACS) at cardiac care units (CCUs) during lockdown and impact on reperfusion strategies adopted during this time period in comparison with the previous year. Materials and Methods: We conducted a multicenter retrospective observational survey on admissions for ACS at CCUs of Ernakulam district in Kerala from January to May 15, 2020. Records were analyzed for admissions during equivalent period of 2019. Trends in admissions during lockdown phases were analyzed separately. Results: We observed an 18.2% reduction in admissions for ACS during lockdown. A significant reduction in number of patients presenting with ST elevation myocardial infarction (STEMI) (186 vs. 169 and 130 vs. 82) was observed when compared to 2019 (P = 0.0047). Decrease in number of primary angioplasties was noted during lockdown phase (302 vs. 244. P = 0.049). There was an increase in adoption of thrombolysis as reperfusion modality at tertiary care centers during lockdown period (27.1% vs. 40.8%). We did not observe an increase in number of patients who presented late during this phase and there was no heterogenicity in admission pattern according to hospital location. Conclusion: Study confirms a significant reduction in admissions for ACS during lockdown period and change in reperfusion strategies adopted during lockdown.