Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19
Santiago Garcia1, Payam Dehghani2, Larissa Stanberry3
1Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
Insights
In-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 decreased significantly from 2020 to 2021. Vaccination status was associated with improved survival in STEMI patients with COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Early pandemic data showed high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19.
- The North American COVID-19 STEMI (NACMI) registry was established to track these outcomes.
Purpose of the Study:
- To describe trends in clinical characteristics, management, and outcomes of STEMI patients with COVID-19 over the course of the pandemic.
- To compare data from the first year (2020) versus the second year (2021) of the pandemic.
Main Methods:
- Analysis of prospective, observational data from the NACMI registry.
- Comparison of 227 STEMI patients with COVID-19 treated in 2020 versus 359 treated in 2021.
- Evaluation of changes in patient demographics, symptoms, management, and in-hospital mortality.
Main Results:
- Patient characteristics evolved, with more Caucasian patients and typical ischemic symptoms in 2021.
- In-hospital mortality decreased from 33% in 2020 to 23% in 2021 (P=0.008).
- None of the 22 vaccinated patients in 2021 expired, compared to 22% mortality in unvaccinated patients (P=0.009).
Conclusions:
- Significant changes in clinical presentation and outcomes were observed for STEMI patients with COVID-19 during the pandemic.
- The data suggest an improvement in outcomes over time, potentially influenced by factors including vaccination.
Background:
We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic.
Objectives:
The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic.
Methods:
The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021).
Results:
A total of 586 COVID-19-positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients' characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009).
Conclusions:
Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.
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