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.
ABSTRACT
Aortic emergencies are surgically challenging and the mortality rate remains high. Since December 2003, we have performed endovascular treatment with a stent graft (EVT) in 15 cases of aortic emergency, including 8 cases of aortic rupture or traumatic aortic disruption, 1 case of traumatic iliac artery disruption, 3 cases of aortobronchial fistula (ABF), and 3 cases of aortoenteric fistula (AEF). In 9 cases of aortic rupture and traumatic aortic or iliac disruption, 1 patient died due to traumatic cerebral hemorrhage, but the remaining 8 patients were discharged without complications. While hemoptysis was resolved in all 3 patients with ABF, 1 patient with primary ABF died due to pneumonia, and 1 patient with secondary ABF died due to multiple organ failure. Furthermore, 1 patient with primary AEF progressed well without any evidence of postprocedural stent graft infection. In 2 patients with secondary AEF, both required secondary surgical graft excision, and 1 of these died due to the recurrence of infection. EVT has shown good results in hemostasis for aortic emergency. However, if a source of infection persists, secondary surgical intervention is required in some cases. Commercially available endovascular stent graft make it possible to treat tortuous segments of the thoracic aorta and the abdominal aorta, therefore we expect there to be more patients with aortic emergencies who require EVT.