Comparative Analysis of Patients With STEMI and COVID-19 Between Canada and the United States
Jay S Shavadia1, Larissa Stanberry2, Jyotpal Singh3
1Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Insights
Comparing US and Canadian care for ST-elevation myocardial infarction (STEMI) with COVID-19, researchers found no difference in in-hospital mortality. Vaccination significantly reduced mortality risk in STEMI-COVID patients across both countries.
Area of Science:
- Cardiology and Infectious Diseases
- Comparative Health Systems Research
Background:
- Significant healthcare disparities exist between the US and Canada, potentially worsened by the COVID-19 pandemic.
- This study focuses on patients experiencing ST-elevation myocardial infarction (STEMI) concurrently with COVID-19 (STEMI-COVID).
Purpose of the Study:
- To compare clinical characteristics, treatment strategies, and outcomes of STEMI-COVID patients in the US versus Canada.
- To investigate the association between vaccination status and clinical outcomes in STEMI-COVID patients.
Main Methods:
- Utilized the North American COVID-19 Myocardial Infarction registry, a prospective study of STEMI patients with confirmed or suspected COVID-19.
- Enrolled 853 patients across the US and Canada, with 112 in Canada.
- Primary endpoint was in-hospital mortality; secondary analysis explored vaccination impact.
Main Results:
- Canadian patients were more likely to present with chest pain and less likely to have prior heart failure, stroke, pulmonary infiltrates, or renal failure.
- Primary percutaneous coronary intervention was the main reperfusion strategy in both countries, with similar door-to-balloon times.
- No significant difference in adjusted in-hospital mortality was observed between the US and Canada (RR 1.0; P=1.0).
- Unvaccinated STEMI-COVID patients had a significantly higher risk of in-hospital mortality compared to vaccinated patients (RR 4.7; P=0.015).
Conclusions:
- While differences in patient morbidities and reperfusion strategies exist between the US and Canada for STEMI-COVID, in-hospital mortality rates were comparable.
- Vaccination status emerged as a strong independent predictor of lower in-hospital mortality, irrespective of geographic region.
- Findings underscore the critical role of vaccination in mitigating mortality risk for STEMI patients with COVID-19.
Background:
Important health care differences exist between the United States (US) and Canada, which may have been exacerbated during the pandemic. We compared clinical characteristics, treatment strategies, and clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 (STEMI-COVID) treated in the US and Canada.
Methods:
The North American COVID-19 Myocardial Infarction registry is a prospective, investigator-initiated study enrolling patients with STEMI with confirmed or suspected COVID-19 in the US and Canada. The primary end point was in-hospital mortality. Additionally, we explored associations between vaccination and clinical outcomes.
Results:
Of 853 patients with STEMI-COVID, 112 (13%) were enrolled in Canada, and compared with the US, patients in Canada were more likely to present with chest pain and less likely to have a history of heart failure, stroke/transient ischemic attack, pulmonary infiltrates or renal failure. In both countries, the primary percutaneous coronary intervention was the dominant reperfusion strategy, with no difference in door-to-balloon times; fibrinolysis was used less frequently in the US than in Canada. The adjusted in-hospital mortality was not different between the 2 countries (relative risk [RR], 1.0; 95% CI, 0.46-2.72; P = 1.0). However, the risk of in-hospital mortality was significantly higher in unvaccinated compared with vaccinated patients with STEMI-COVID (RR, 4.7; 95% CI, 1.7-11.53; P = .015).
Conclusions:
Notable differences in morbidities and reperfusion strategies were evident between patients with STEMI-COVID in the US compared with Canada. No differences were noted for in-hospital mortality. Vaccination, regardless of region, appeared to associate with a lower risk of in-hospital mortality strongly.
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