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Jabir A, Geevar Zachariah, Mohanan PP, Gupta MD, Ramakrishnan S, Meena CB, Sridhar L, Girish MP, Das DR, Gupta A, Praveen Nagula, Tom Devasia, Bhavesh Vajifdar, Kamlesh Thakkar, Urmil Shah, Tanuj Bhatia, Smit Srivastava, Sanjeev Sharma, Priya Kubendiran, Jayagopal PB, Sudeep Kumar, Deepthy Sadanandan, Lincy Mathew, Nitish Naik, Anup Banerji, Ashraf SM, Asokan PK, Bharti BB, Majumder B, Dhiman Kahali, Sinha DP, Sharma D, Dastidar DG, Dipankar Mukhapdhyay, Wander GS, Bali HK, Kesavamoorthy B, Agarwala MK, Khanna NN, Natesh BH, Goel PK, Chakraborty RN, Jain RK, Rakesh Yadav, Sameer Dani L, Satyavan Sharma, Satyendra Tewari, Sethi KK, Sharad Chandra, Mandal S, Bhandari S, Sikdar S, Vivek Gupta, Rath PC, Bang VH, Debabrata Roy, Das MK, Banerjee PS. COVID-19 infected ST-Elevation myocardial infarction in India (COSTA INDIA). Indian Heart J 2023; 75:243-250. [PMID: 37230465 PMCID: PMC10204278 DOI: 10.1016/j.ihj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE To find out differences in the presentation, management and outcomes of COVID-19 infected STEMI patients compared to age and sex-matched non-infected STEMI patients treated during the same period. METHODS This was a retrospective multicentre observational registry in which we collected data of COVID-19 positive STEMI patients from selected tertiary care hospitals across India. For every COVID-19 positive STEMI patient, two age and sex-matched COVID-19 negative STEMI patients were enrolled as control. The primary endpoint was a composite of in-hospital mortality, re-infarction, heart failure, and stroke. RESULTS 410 COVID-19 positive STEMI cases were compared with 799 COVID-19 negative STEMI cases. The composite of death/reinfarction/stroke/heart failure was significantly higher among the COVID-19 positive STEMI patients compared with COVID-19 negative STEMI cases (27.1% vs 20.7% p value = 0.01); though mortality rate did not differ significantly (8.0% vs 5.8% p value = 0.13). Significantly lower proportion of COVID-19 positive STEMI patients received reperfusion treatment and primary PCI (60.7% vs 71.1% p value=< 0.001 and 15.4% vs 23.4% p value = 0.001 respectively). Rate of systematic early PCI (pharmaco-invasive treatment) was significantly lower in the COVID-19 positive group compared with COVID-19 negative group. There was no difference in the prevalence of high thrombus burden (14.5% and 12.0% p value = 0.55 among COVID-19 positive and negative patients respectively) CONCLUSIONS: In this large registry of STEMI patients, we did not find significant excess in in-hospital mortality among COVID-19 co-infected patients compared with non-infected patients despite lower rate of primary PCI and reperfusion treatment, though composite of in-hospital mortality, re-infarction, stroke and heart failure was higher.
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Affiliation(s)
| | | | | | | | | | | | - L Sridhar
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.
| | | | | | | | | | - Tom Devasia
- Kasturba Medical College Manipal, Karnataka, India.
| | - Bhavesh Vajifdar
- Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | | | | | - Smit Srivastava
- Dr Bhim Rao Ambedhkar Memorial Hospital, Raipur, Chhattisgarh, India.
| | | | - Priya Kubendiran
- G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India.
| | | | - Sudeep Kumar
- Sanjay Gandhi Postgraduate of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | | | | | - Nitish Naik
- All India Institute of Medical Sciences, Delhi, India.
| | - Anup Banerji
- Medica Superspeciality Hospital, Kolkata, West Bengal, India.
| | - S M Ashraf
- Government Medical College, Kannur, Kerala, India.
| | - P K Asokan
- Fathima Hospital, Kozhikode, Kerala, India.
| | | | | | - Dhiman Kahali
- B M Birla Heart Research Centre, Kolkata, West Bengal, India.
| | | | - Dipak Sharma
- Christian Medical Centre Hospital, Jorht, Assam, India.
| | | | | | | | | | - B Kesavamoorthy
- Meenakshi Multispeciality Hospital, Trichy, Tamil Nadu, India.
| | | | | | - B H Natesh
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bengaluru, Karnataka, India.
| | | | | | | | | | - L Sameer Dani
- Apollo CVHF Heart Institute, Ahmedabad, Gujarat, India.
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - K K Sethi
- Delhi Heart and Lung Institute, New Delhi, India.
| | - Sharad Chandra
- King George Medical University, Lucknow, Uttar Pradesh, India.
| | - Subrato Mandal
- Ubuntu Heart and Superspeciality Hospital, Bhopal, Madhya Pradesh, India.
| | | | | | | | | | | | - Debabrata Roy
- N H Rabindranatha Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India.
| | - Mrinal Kanti Das
- The Calcutta Medical Research Institute, Kolkata, West Bengal, India.
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Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath C, Sethi R, Guha S, Satheesh S, Dhaliwal R, Sarma M, Ganapathy S, Jeemon P, Joseph S, Narayanan S, G R, Varghese AC, Damodara R, Joseph J, Davidson D, Thomas JK, George T, Mattummal S, Naik N, Singh S, Sharma G, Seth S, Palleda G, Gupta MD, Kumar P, Kumar N, Susheel M, Vohra MV, Negi PC, Asotra S, Mahajan K, Sharma R, D B, Raj S, Katageri A, Nanjappa V, Shetty R, Katheria R, Rai M, Musthafa M M, DKS S, Selvaraj R, M V, RJ V, Rajasekhar D, V V, Naik KS, Gnanaraj JP, Hussain F, N S, Menon S, TR H, G S, S B, SR V, Alex AG, G S, Yerram S, Bhyravavajhala S, Maddury J, Oruganti SS, Mehrotra S, Dahiya N, Sharma V, Sood A, Mohan B, Tandon R, Singh CN, Monga I, Kashyap JR, Reddy S, Kumar M, Guleria D, Sharma A, Singhal R, Joshi H, Iby M, Roy B, Thakkar P, Choudhary D, Agarwal DK, Swamy A, IC M, Bohora S, Pradhan A, Vishwakarma P, Kapoor A, Kumar S, Jain D, Pande U, Tripathi S, Verma B, Ghosh S, Prajapati R, Vemuri KS, Kaushley A, Chaturvedi S, Jha N, Kumar S, Agrawal AK, Kumar N, Chowdhary S, Shrivastava S, Yadav B, Gupta R, Singh R, Singh G, Bagchi PC, Kumari T, Agrawal MK, Mondal M, Mandal SC, Mitra KK, Routray S, Das DR, Mishra TK, Malviya A, Laitthma A, Dorjee R, Kalita HC, Chaliha MS, Dutta DJ, Tramboo NA, Rashid A, Singh Rao R, Chaturvedi H, Naik GD, Nevrekar R. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail 2022; 9:3898-3908. [PMID: 36214477 PMCID: PMC9773752 DOI: 10.1002/ehf2.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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Affiliation(s)
| | - Ajay Bahl
- CardiologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Ambuj Roy
- CardiologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Animesh Mishra
- CardiologyNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)ShillongIndia
| | - Jayesh Prajapati
- CardiologyUN Mehta Institute of Cardiology and Research Centre (UNMICRC)AhmedabadIndia
| | - C.N. Manjunath
- CardiologySri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR)BangaloreIndia
| | - Rishi Sethi
- CardiologyKing George's Medical University (KGMU)LucknowIndia
| | - Santanu Guha
- CardiologyMedical College Hospital (MCH)KolkataIndia
| | - Santhosh Satheesh
- CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
| | - R.S. Dhaliwal
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Meenakshi Sarma
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Sanjay Ganapathy
- CardiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)TrivandrumIndia
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)Trivandrum695011KeralaIndia
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Kumar A, Das B, Routray S, Mishra C, Das DR. Prognostic value of HbA1C in predicting the short term outcome in diabetic patients with ACS. Indian Heart J 2021. [DOI: 10.1016/j.ihj.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zachariah G, Ramakrishnan S, Das MK, Jabir A, Jayagopal PB, Venugopal K, Mani K, Khan AK, Malviya A, Gupta A, Goyal A, Singh BP, Mohan B, Bharti BB, Majumder B, Wilson B, Karunadas CP, Meena CB, Manjunath CN, Cibu M, Roy D, Choudhary D, Das DR, Sarma D, Girish MP, Wander GS, Wardhan H, Ezhilan J, Tummala K, Katyal VK, Goswami K, Subramanyam K, Goyal KK, Kumar K, Pathak LA, Bansal M, Mandal M, Gupta MD, Khanna NN, Hanumanthappa NB, Bardoloi N, Modi N, Naik N, Hasija PK, Kerkar P, Bhattacharyya PJ, Gadkari P, Chakraborthy RN, Patil RR, Gupta R, Yadav R, Murty RS, Nath RK, Sivakumar R, Sethi R, Baruah R, Tyagi S, Guha S, Krishnappa S, Kumar S, Routray SN, Tewari S, Ray S, Reddy SS, Chandra S, Gupta SB, Chatterjee SS, Siddiqui KKH, Sivabalan M, Yerram S, Kumar S, Nagarajan S, Devasia T, Jadhav U, Narain VS, Garg VK, Gupta VK, Prabhakaran D, Deb PK, Mohanan PP. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic. Indian Heart J 2021; 73:413-423. [PMID: 34474751 PMCID: PMC8424286 DOI: 10.1016/j.ihj.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
AIM Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | - Kalaivani Mani
- Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Malviya
- Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India
| | | | | | - B P Singh
- Department of Cardiology, Indra Gandhi Institute of Medical Sciences, Patna, India
| | | | | | | | | | | | | | | | | | - Debabrata Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - Dipak Sarma
- Christian Medical Centre Hospital, Jorhat, India
| | | | | | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Virender Kumar Katyal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Kewal Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | - Manoranjan Mandal
- Department of Cardiology, Nil Ratan Sircar Medical College, Kolkata, India
| | | | | | | | | | | | - Nitish Naik
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Rishi Sethi
- King George Medical University, Lucknow, India
| | | | - Sanjay Tyagi
- Department of Cardiology, GB Pant Hospital, New Delhi, India
| | | | - Santhosh Krishnappa
- Cardiology Department, Sri Jayadeva Institute of Cardiovascular Science and Research, Mysore, India
| | | | - Satya Narayan Routray
- Department of Cardiology, Srirama Chandra Bhanja Medical College and Hospital, Odissa, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | | | | | | | | | | | | | - Sreekanth Yerram
- Department of Cardiology, Nizam's Institute of Medical Science, Hyderabad, India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | - Uday Jadhav
- Consultant in Cardiology Department, MGM New Bombay Hospital, Mumbai, India
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