Influence of COVID-19 pandemic in India on coronary artery disease clinical presentation, angiography, interventions and in-hospital outcomes: a single centre prospective registry-based observational study.

Publication date: Mar 29, 2024

The study examined the influence of the COVID-19 pandemic in India on variation in clinical features, management and in-hospital outcomes in patients undergoing percutaneous coronary intervention (PCI). Prospective registry-based observational study. A tertiary care hospital in India participant in the American College of Cardiology CathPCI Registry. 7089 successive patients who underwent PCI from April 2018 to March 2023 were enrolled (men 5627, women 1462). Details of risk factors, clinical presentation, coronary angiography, coronary interventions, clinical management and in-hospital outcomes were recorded. Annual data were classified into specific COVID-19 periods according to Government of India guidelines as pre-COVID-19 (April 2018 to March 2019, n=1563; April 2019 to March 2020, n=1594), COVID-19 (April 2020 to March 2020, n=1206; April 2021 to March 2022, n=1223) and post-COVID-19 (April 2022 to March 2023, n=1503). Compared with the patients in pre-COVID-19 and post-COVID-19 periods, during the first COVID-19 year, patients had more hypertension, non-ST elevation myocardial infarction (NSTEMI), lower left ventricular ejection fraction (LVEF) and multivessel coronary artery disease (CAD). In the second COVID-19 year, patients had more STEMI, lower LVEF, multivessel CAD, primary PCI, multiple stents and more vasopressor and mechanical support. There were 99 (1. 4%) in-hospital deaths which in the successive years were 1. 2%, 1. 4%, 0. 8%, 2. 4% and 1. 3%, respectively (p=0. 019). Compared with the baseline year, deaths were slightly lower in the first COVID-19-year (age-sex adjusted OR 0. 68, 95% CI 0. 31 to 1. 47) but significantly more in the second COVID-19-year (OR 1. 97, 95% CI 1. 10 to 3. 54). This variation attenuated following adjustment for clinical presentation, extent of CAD, in-hospital treatment and duration of hospitalisation. In-hospital mortality among patients with CAD undergoing PCI was significantly higher in the second year of the COVID-19 pandemic in India and could be one of the reasons for excess deaths in the country. These patients had more severe CAD, lower LVEF, and more vasopressor and mechanical support and duration of hospitalisation.

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Concepts Keywords
Cardiology Coronary intervention
Covid COVID-19
Severe SARS-CoV-2 Infection

Semantics

Type Source Name
disease MESH COVID-19 pandemic
disease MESH coronary artery disease
disease IDO intervention
disease MESH hypertension
disease MESH ST elevation myocardial infarction
disease MESH NSTEMI
disease IDO country
disease MESH myocardial infarction
disease MESH emergencies
disease MESH strokes
drug DRUGBANK Esomeprazole
drug DRUGBANK Coenzyme M
drug DRUGBANK Angiotensin II
disease MESH chronic kidney disease
disease VO protocol
disease MESH unstable angina
drug DRUGBANK Norepinephrine
drug DRUGBANK Dopamine
drug DRUGBANK Vasopressin

Original Article

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