Demographics, clinical characteristic, management strategy and outcome in patients with cardiovascular emergencies
| Pre-COVID period | Pre-lockdown period | Lockdown period | P value | |
| No of emergency admissions | 1488 | 830 | 289 | |
| Age (years) (mean±SD) | 61.1±11.9 | 58.1±11.2 | 61.7±12.4 | <0.001 |
| Men (n (%)) | 1057 (71.04) | 597 (71.93) | 257 (88.93) | <0.001 |
| STEMI (n (%) | 588 (39.52) | 276 (33.25) | 192 (66.44) | <0.001 |
| NSTEMI (n (%)) | 504 (33.87) | 336 (40.48) | 36 (12.46) | <0.001 |
| Acute decompensated heart failure (n (%)) | 240 (16.13) | 112 (13.49) | 31 (10.73) | 0.030 |
| Advanced* or third degree AV block† (n (%)) | 156 (10.48) | 106 (12.77) | 30 (10.38) | 0.021 |
| Management of STEMI (n (%)) | ||||
| Outside window period | 36 (6.12) | 48 (17.39) | 48 (25.00) | <0.001 |
| Thrombolysis | 108 (18.37) | 85 (30.80) | 62 (32.29) | <0.001 |
| Pharmacoinvasive‡ | 168 (28.57) | 71 (25.072) | 46 (23.96) | 0.002 |
| Primary percutaneous coronary intervention | 276 (46.94) | 72 (26.09) | 36 (18.75) | <0.001 |
| NSTEMI patients managed conservatively (n (%)) | 32 (6.34) | 69 (20.54) | 29 (80.56) | <0.001 |
| ACS patients associated with risk factors§ (n (%)) | 120 (10.99) | 108 (17.65) | 71 (31.14) | <0.001 |
| Ejection fraction (%) (mean±SD) | 47.52±10.0 | 43.63±9.6 | 37.85±10.4 | <0.001 |
| Inhospital mortality (n (%)) | 40 (2.69) | 29 (3.49) | 21 (7.27) | <0.001 |
The pre-COVID period was defined as the period when there were no COVID-19 cases (25 January to 24 February 2020), the pre-lockdown period was defined as the period when there were COVID-19 cases but no lockdown was imposed (25 February to 24 March 24) and the lockdown period was defined as the period when total lockdown was imposed by the government of India (25 March to 24 April 2020).
*Advanced, high grade or high degree of AV block: ≥2 consecutive P waves at a constant physiological rate that did not conduct to the ventricles with evidence of some AV conduction.
†Third degree AV block (complete heart block): no evidence of AV conduction.
‡Pharmacoinvasive approach is defined as a strategy where fibrinolysis is followed by immediate transfer to a PCI capable hospital for either rescue PCI in the case of failed fibrinolysis or routine coronary angiography and PCI in the case of successful fibrinolysis.
§Risk factors associated with poor prognosis in ACS were cardiogenic shock, heart failure, ventricular arrhythmia, complete heart block and acute kidney injury.
ACS, acute coronary syndrome; AV, atrioventricular; NSTEMI, non-ST elevation myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST elevation myocardial infarction.