Initial Findings From the North American COVID-19 Myocardial Infarction Registry

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic significantly disrupted ST-elevation myocardial infarction (STEMI) care, particularly access to primary percutaneous coronary intervention (PPCI).
• Understanding the impact of COVID-19 on STEMI patients is crucial for optimizing care pathways.

Purpose of the Study:

• To describe the demographic characteristics, management strategies, and clinical outcomes of STEMI patients with confirmed or suspected COVID-19.
• To compare these characteristics and outcomes against a pre-COVID-19 control group.

Main Methods:

• The North American COVID-19 and STEMI (NACMI) registry prospectively collected data on STEMI patients with confirmed COVID-19 (COVID+), suspected COVID-19 (person under investigation [PUI]), and a pre-COVID control group.
• The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization.

Main Results:

• COVID+ STEMI patients were more likely to be of minority ethnicity and have diabetes, presenting with cardiogenic shock but receiving less invasive angiography compared to controls.
• Despite reduced angiography rates, primary percutaneous coronary intervention (PPCI) was utilized in 71% of COVID+ patients who underwent angiography.
• The primary composite outcome occurred in 36% of COVID+ patients, significantly higher than PUIs (13%) and control patients (5%).

Conclusions:

• STEMI patients with COVID-19 represent a high-risk population with distinct demographic and clinical profiles.
• Primary percutaneous coronary intervention (PPCI) is a feasible and predominant reperfusion strategy, aligning with current clinical recommendations for STEMI management during the pandemic.