Baseline ECG Outperforms the Angiogram for Predicting Mortality in COVID-19-Associated STEMI: Insights From the NACMI...

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Diagnostics

Background:

• COVID-19 is associated with ST-elevation myocardial infarction (STEMI).
• Core laboratory electrocardiogram (ECG) descriptions for COVID-19-associated STEMI are lacking.
• This study evaluates ECG characteristics and coronary angiograms in hospitalized COVID-19 patients with STEMI.

Purpose of the Study:

• To analyze ECG characteristics of COVID-19-associated STEMI.
• To correlate ECG findings with coronary angiograms.
• To identify ECG predictors of in-hospital mortality in this patient group.

Main Methods:

• Analysis of baseline STEMI ECGs from the North American COVID-19 Myocardial Infarction (NACMI) registry.
• Core laboratory interpretation of ECGs, including ST-segment analysis (ST-E, ΣST-E, ΣST-D).
• Collection and review of available coronary angiograms; analysis of ECG and angiographic variables associated with in-hospital death.

Main Results:

• 28.1% of patients died in-hospital.
• Greater ST-segment deviation (ST-E, ΣST-E, ΣST-D) was observed in patients who died.
• Adjusted analysis revealed ΣST-D as a positive predictor of in-hospital death (RR, 1.03; 95% CI, 1.01-1.05).
• ECG characteristics (ST-E, ΣST-E, ΣST-D) were independent predictors of in-hospital mortality after adjustment.

Conclusions:

• ST-segment deviation in ECGs of COVID-19 patients with STEMI predicts in-hospital mortality.
• These findings suggest microthrombi affecting myocardial perfusion.
• ECG serves as a valuable tool for risk stratification in COVID-19-associated STEMI.