Title : A clinical profile of acute coronary syndrome in COVID-19 patients in a provincial town of south India
Background: COVID-19 pa,ents are at a higher rick of ACS as associated inflammatory response leads to endothelial damage and plaque rupture. The clinical data of such pa,ents presen,ng with ACS is limited, we did a clinical study of ACS with COVID-19 pa,ents focusing chiefly on clinical profile.
Methods and Materials: A total 25 pa,ents with ACS and COVID-19 were enrolled in the studied, ACS was diagnosed by clinical presenta,on, ECG and cardiac biomarkers. COVID-19 was diagnosed by RT-PCR, evidence of pneumonia on HRCT thorax and COVID-19 IgG an,bodies was done to confirm the post-COVID status. COVID-19 IgG an,body immunoassay was done by CLIA method, which is authorized by EUA.
Results: A total 25 pa,ents were enrolled in this studied, out of which 18 pa,ents presented with ACS and were later diagnosed to have COVID-19, and 7 pa,ents who were already being treated for COVID-19, developed ACS during the hospital course. Chest pain was the most common clinical presenta,on, which was seen in 23 pa,ents, second most common symptom was dyspnea which was present in 9 pa,ents and fever was present in 7 pa,ents. ST segment eleva,on MI (STEMI) was the most common type of ACS found i.e. 14 pa,ents (7 were anterior wall STEMI and 7 were inferior wall STEMI). Non-ST segment eleva,on MI (NSTEMI) was seen in 8 pa,ents and unstable angina was seen in 3 pa,ents. Pa,ents with STEMI had sta,s,cally significant (P value <0.05) higher levels of inflammatory markers (serum LDH, serum Ferri,n, IL-6, d-dimer). Thrombolysis was done in 8 pa,ents (6 pa,ents with Tenectaplase and 2 with streptokinase). 6 pa,ents died, in which all were STEMI, and their inflammatory markers were sta,s,cally (P value <0.05) on higher side (serum LDH, serum ferri,n and d-dimer). Pa,ents with NSTEMI and unstable angina had lower levels of inflammatory markers. 15 pa,ents had no comorbid condi,ons, rest 10 pa,ents had comorbid condi,ons like hypertension, diabetes, smokers ,bronchial asthma and old ischemic heart disease. Among the 25 pa,ents, 13 pa,ents were RT-PCR posi,ve and 12 pa,ents were post-COVID status and had posi,ve COVID-19 IgG an,body ,tres.
Conclusion: The uniqueness about this study is that majority of the pa,ents (18 pa,ents) presented with ACS and later on diagnosed to have COVID-19. Most pa,ents had ST segment eleva,on MI. Mortality was seen only in pa,ents with STEMI, possibly due to extreme thrombo,c burden. Sta,s,cal correla,on with mortality was observed with serum LDH, serum ferri,n and d-dimer, hence these inflammatory markers can be considered prognos,c markers. Pa,ents with NSTEMI and unstable angina showed favourable clinical course and low levels of inflammatory markers.