Initial Findings From the North American COVID-19 Myocardial Infarction Registry.
covid-19, Outcomes, ST-segment myocardial infarction
The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.
Santiago Garcia, Payam Dehghani, Cindy Grines, Laura Davidson, Keshav R Nayak, Jacqueline Saw, Ron Waksman, John Blair, Bagai Akshay, Ross Garberich, Christian Schmidt, Hung Q Ly, Scott Sharkey, Nestor Mercado, Carlos E Alfonso, Naoki Misumida, Deepak Acharya, Mina Madan, Abdul Moiz Hafiz, Nosheen Javed, Jay Shavadia, Jay Stone, M Chadi Alraies, Wah Htun, William Downey, Brian A Bergmark, Jospeh Ebinger, Tareq Alyousef, Houman Khalili, Chao-Wei Hwang, Joshua Purow, Alexander Llanos, Brent McGrath, Mark Tannenbaum, Jon Resar, Rodrigo Bagur, Pedro Cox-Alomar, Ada C Stefanescu Schmidt, Lindsey A Cilia, Farouc A Jaffer, Michael Gharacholou, Michael Salinger, Brian Case, Ameer Kabour, Xuming Dai, Osama Elkhateeb, Taisei Kobayashi, Hahn-Ho Kim, Mazen Roumia, Frank V Aguirre, Jeffrey Rade, Aun-Yeong Chong, Hurst M Hall, Shy Amlani, Alireza Bagherli, Rajan A G Patel, David A Wood, Frederick G Welt, Jay Giri, Ehtisham Mahmud, Timothy D Henry
Journal of the American College of Cardiology