Impact of COVID-19 Pandemic on acute cardiac emergencies: ST- Elevation Myocardial Infarction, Acute Aortic Dissection and Ventricular Septal Rupture

Abstract

Aim: To evaluate the influence of the Covid‐ 19 pandemic on Acute Cardiac Emergencies, namely, ST-Elevation
Myocardial Infarction (STEMI), Acute Aortic dissection (AAD) and Ventricular Septal Rupture (VSR) at a tertiary care
hospital in India. Methods: A total of 880 acute cardiac emergencies patients presenting at the emergency department at
a tertiary cardiac care centre, diagnosed with STEMI, VSR and AAD were included in the study. Results: A notable
reduction in the number of STEMI, VSR and AAD patients presenting to the emergency department was observed
coinciding with the COVID-19 pandemic. In STEMI patients the average time from onset of signs and symptoms to first
medical contact changed from a central tendency of 5.5 hours pre Covid-19 to 6 hours post Covid-19 ; door to balloon
time changed from a central tendency of 90 minutes pre Covid-19 to 82.5 minutes post Covid-19 ; a reduced ejection
fraction of less than or equal to 40% was seen in 37.22% of patients pre Covid-19 to 50.7% of patients post Covid-19 ;
Percentage of patients in Killip class-1 and Killip class-3 decreased from 84.09% to 69.85% and 1.13% to 0.73%
respectively post pandemic. And the percentage of patients in Killip class-2 and Killip class-4 increased from 4.82% to
13.23%, and 9.94% to 16.17% respectively post-pandemic. We observed a sharp fall in acute cardiac emergency patients
post Janta Curfew declared on March 22
nd
, 2020. There was also a rise in STEMI and VSR patients seen post Unlock 4
declared on September 1
st
, 2020. Conclusion: The COVID-19 pandemic has significantly decreased the presentations of
acute cardiac emergencies at our tertiary care hospital. There was also a significant delay in time from onset of signs and
symptoms to first medical contact. There was no impact on the quality of care given to patients, in fact a decrease in door
to balloon time was seen post pandemic at our centre. However, patients presented with a lower ejection fraction and
higher Killip’s classification post pandemic. This indicates the possibility of increased mortality and morbidity of such
patients, which is a matter of public health concern globally. It is important that we address this by increasing access to
immediate healthcare facilities via tele-consultation.