Consensus evidence-based guidelines for management of hyperglycaemia in patients undergoing coronary artery bypass grafting in patients with diabetes in India.

Diabetes is associated with a significant risk of cardiovascular diseases (CVDs). Patients with diabetes are known to suffer from a disproportionately large burden of CVDs, in terms of higher risk, worse prognosis and more adverse outcomes. Acute coronary syndromes, including coronary artery disease, represent a large proportion of this burden and conventionally coronary artery bypass grafting (CABG) has been the mainstay of facilitating reperfusion in patients with diabetes. However, hyperglycaemia is an important factor which affects the outcomes of CABG and shows a grave impact on patients' well-being. Thus, it is important to appropriately manage hyperglycaemia in the peri-and intra-operative periods to assure the best possible outcomes in patients with diabetes. There is scant evidence to show that oral antidiabetic drugs (OADs) or non-insulin based therapies show considerable benefit in patients undergoing CABG. Even with the use of insulin-based therapies, appropriate glycaemic targets, accurately designed algorithm to achieve such targets and specific recommendations to facilitate the appropriate use of such algorithm are important considerations. However, current international guidelines are either country-specific or fail to address context-specific needs in individual countries. In view of the growing incidence of cardiovascular diseases and diabetes in India, as a result of changing lifestyles, it is imperative upon clinicians to formulate India-specific guidelines for effective management of (CVDs). It is the endeavour of the current guideline to present recommendations based on a firm evidentiary foundation coupled with context-specific inputs from experts' consensus opinion. These recommendations represent an effort to address the urgent need for such an exercise both in the academic as well as the clinical realm.

Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design.

BACKGROUND: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. METHODS: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. CONCLUSIONS: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.