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Persistent One-Year Mortality Gradient After STEMI and COVID-19: Long-Term Outcomes From the NACMI Registry

Payam Dehghani1, Chase J Ellingson1,2, Jyotpal Singh1

  • 1Prairie Vascular Research Inc, Regina, Saskatchewan, Canada.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 21, 2026
PubMed

Insights

Patients with ST-elevation myocardial infarction (STEMI) and COVID-19 face significantly higher mortality risks, extending beyond initial hospitalization. This increased risk persists even for survivors, highlighting the long-term impact of COVID-19 on STEMI outcomes.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Patients with ST-elevation myocardial infarction (STEMI) and COVID-19 exhibit elevated in-hospital mortality.
  • The North American COVID-19 Myocardial Infarction (NACMI) registry provides data on these patients.
  • Historical controls and COVID-19-negative patients serve as comparators.

Purpose of the Study:

  • To examine the 1-year mortality outcomes in patients with STEMI and COVID-19.
  • To assess the long-term impact of COVID-19 on STEMI patient survival.
  • To identify risk gradients in mortality for COVID-19 positive STEMI patients.

Main Methods:

  • A substudy of NACMI centers with long-term follow-up was conducted.
  • STEMI patients were stratified into COVID-19-positive, COVID-19-negative, and historical control groups.
  • One-year mortality was the primary outcome measure.

Main Results:

  • One-year mortality was 45% for COVID-19-positive STEMI patients versus 27% for COVID-19-negative and 11% for historical controls.
  • The majority of deaths (86%) occurred during the initial hospitalization.
  • Among survivors, 1-year mortality remained higher in COVID-19-positive (12%) and COVID-19-negative (9.6%) groups compared to controls (5.3%).

Conclusions:

  • The excess mortality risk associated with COVID-19 STEMI extends beyond the index hospitalization.
  • A clear risk gradient in mortality is observed, influenced by multifactorial causes.
  • Pandemic-era care disruptions, delayed treatment, and COVID-19 pathophysiology contribute to adverse outcomes.
Abstract

Keywords:
COVID-19STEMIcoronavirusmyocardial infarction

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