Baseline ECG Outperforms the Angiogram for Predicting Mortality in COVID-19-Associated STEMI: Insights From the NACMI
Kevin R Bainey1,2, Payam Dehghani3, Jyotpal Singh3
1Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
Insights
Electrocardiogram (ECG) ST-segment deviation in ST-elevation myocardial infarction (STEMI) patients with COVID-19 predicts in-hospital death. These ECG findings may indicate microthrombi, highlighting ECG
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.
Background:
Patients with COVID-19 continue to present with ST-elevation myocardial infarction (STEMI). To date, there have been no core laboratory electrocardiogram (ECG) description of these patients. Accordingly, we aimed to evaluate the ECG characteristics and coronary angiograms of patients hospitalized with COVID-19-associated STEMI.
Methods:
In a prespecified analysis from the North American COVID-19 Myocardial Infarction (NACMI) registry, we collected baseline STEMI ECGs in COVID-19-positive patients for core laboratory interpretation (Canadian VIGOUR Centre, Edmonton, Canada), including ST-segment analysis, worst lead ST-elevation (ST-E), sum ST-elevation (ΣST-E), and sum ST deviation (ΣST-D). Available core laboratory angiograms (Cardiovascular Imaging Research Core Laboratory, Vancouver, Canada) were also collected. ECG and angiographic variables associated with in-hospital death were analyzed.
Results:
Of the 392 patients, 28.1% died in-hospital. Greater median ST-E (deviation) was observed in those who died (ST-E: 2.20 vs 1.65 mm; P = .006; ΣST-E: 7 vs 5 mm; P = .005; ΣST-D: 11 vs 9 mm; P = .013, respectively). Following adjustment for clinical characteristics, ΣST-D was a positive predictor of in-hospital death (relative risk [RR], 1.03; 95% CI, 1.01-1.05; P = .003). In 173 patients with available coronary angiograms, 32% of the baseline ECGs could not define infarct location (19% with angiography). Following adjustment, only ECG characteristics were independent predictors of in-hospital mortality (ST-E: RR, 1.14; 95% CI, 1.04-1.22; ΣST-E: RR, 1.03; 95% CI. 1.01-1.05: ΣST-D: RR, 1.03; 95% CI, 1.01-1.05).
Conclusions:
In COVID-19-positive patients with STEMI, ST-E (deviation) is a predictor of in-hospital mortality and likely reflects microthrombi in multiple territories compromising myocardial perfusion. Our data support ECG as a simple tool to help risk stratify patients with COVID-19-associated STEMI.
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