Initial Findings From the North American COVID-19 Myocardial Infarction Registry
Santiago Garcia1, Payam Dehghani2, Cindy Grines3
1Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA.
Insights
The North American COVID-19 and STEMI registry found that patients with ST-elevation myocardial infarction (STEMI) and COVID-19 had worse outcomes. Primary percutaneous coronary intervention (PPCI) remains a feasible reperfusion strategy for this high-risk group.
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.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI).
Objectives:
The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI.
Methods:
A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization.
Results:
As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients).
Conclusions:
COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.
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