tetano
Editor, Senior Moderator
J Am Coll Cardiol
. 2021 Apr 27;77(16):1994-2003.
doi: 10.1016/j.jacc.2021.02.055.
Initial Findings From the North American COVID-19 Myocardial Infarction Registry
Santiago Garcia[SUP] 1 [/SUP], Payam Dehghani[SUP] 2 [/SUP], Cindy Grines[SUP] 3 [/SUP], Laura Davidson[SUP] 4 [/SUP], Keshav R Nayak[SUP] 5 [/SUP], Jacqueline Saw[SUP] 6 [/SUP], Ron Waksman[SUP] 7 [/SUP], John Blair[SUP] 8 [/SUP], Bagai Akshay[SUP] 9 [/SUP], Ross Garberich[SUP] 10 [/SUP], Christian Schmidt[SUP] 10 [/SUP], Hung Q Ly[SUP] 11 [/SUP], Scott Sharkey[SUP] 10 [/SUP], Nestor Mercado[SUP] 12 [/SUP], Carlos E Alfonso[SUP] 13 [/SUP], Naoki Misumida[SUP] 14 [/SUP], Deepak Acharya[SUP] 15 [/SUP], Mina Madan[SUP] 16 [/SUP], Abdul Moiz Hafiz[SUP] 17 [/SUP], Nosheen Javed[SUP] 18 [/SUP], Jay Shavadia[SUP] 19 [/SUP], Jay Stone[SUP] 20 [/SUP], M Chadi Alraies[SUP] 21 [/SUP], Wah Htun[SUP] 22 [/SUP], William Downey[SUP] 23 [/SUP], Brian A Bergmark[SUP] 24 [/SUP], Jospeh Ebinger[SUP] 25 [/SUP], Tareq Alyousef[SUP] 26 [/SUP], Houman Khalili[SUP] 27 [/SUP], Chao-Wei Hwang[SUP] 28 [/SUP], Joshua Purow[SUP] 29 [/SUP], Alexander Llanos[SUP] 29 [/SUP], Brent McGrath[SUP] 30 [/SUP], Mark Tannenbaum[SUP] 31 [/SUP], Jon Resar[SUP] 32 [/SUP], Rodrigo Bagur[SUP] 33 [/SUP], Pedro Cox-Alomar[SUP] 34 [/SUP], Ada C Stefanescu Schmidt[SUP] 35 [/SUP], Lindsey A Cilia[SUP] 35 [/SUP], Farouc A Jaffer[SUP] 35 [/SUP], Michael Gharacholou[SUP] 36 [/SUP], Michael Salinger[SUP] 37 [/SUP], Brian Case[SUP] 7 [/SUP], Ameer Kabour[SUP] 38 [/SUP], Xuming Dai[SUP] 39 [/SUP], Osama Elkhateeb[SUP] 40 [/SUP], Taisei Kobayashi[SUP] 41 [/SUP], Hahn-Ho Kim[SUP] 42 [/SUP], Mazen Roumia[SUP] 43 [/SUP], Frank V Aguirre[SUP] 44 [/SUP], Jeffrey Rade[SUP] 45 [/SUP], Aun-Yeong Chong[SUP] 46 [/SUP], Hurst M Hall[SUP] 47 [/SUP], Shy Amlani[SUP] 48 [/SUP], Alireza Bagherli[SUP] 49 [/SUP], Rajan A G Patel[SUP] 50 [/SUP], David A Wood[SUP] 51 [/SUP], Frederick G Welt[SUP] 52 [/SUP], Jay Giri[SUP] 53 [/SUP], Ehtisham Mahmud[SUP] 54 [/SUP], Timothy D Henry[SUP] 55 [/SUP], Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council
Affiliations
Abstract
Background: 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).
Objectives: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
. 2021 Apr 27;77(16):1994-2003.
doi: 10.1016/j.jacc.2021.02.055.
Initial Findings From the North American COVID-19 Myocardial Infarction Registry
Santiago Garcia[SUP] 1 [/SUP], Payam Dehghani[SUP] 2 [/SUP], Cindy Grines[SUP] 3 [/SUP], Laura Davidson[SUP] 4 [/SUP], Keshav R Nayak[SUP] 5 [/SUP], Jacqueline Saw[SUP] 6 [/SUP], Ron Waksman[SUP] 7 [/SUP], John Blair[SUP] 8 [/SUP], Bagai Akshay[SUP] 9 [/SUP], Ross Garberich[SUP] 10 [/SUP], Christian Schmidt[SUP] 10 [/SUP], Hung Q Ly[SUP] 11 [/SUP], Scott Sharkey[SUP] 10 [/SUP], Nestor Mercado[SUP] 12 [/SUP], Carlos E Alfonso[SUP] 13 [/SUP], Naoki Misumida[SUP] 14 [/SUP], Deepak Acharya[SUP] 15 [/SUP], Mina Madan[SUP] 16 [/SUP], Abdul Moiz Hafiz[SUP] 17 [/SUP], Nosheen Javed[SUP] 18 [/SUP], Jay Shavadia[SUP] 19 [/SUP], Jay Stone[SUP] 20 [/SUP], M Chadi Alraies[SUP] 21 [/SUP], Wah Htun[SUP] 22 [/SUP], William Downey[SUP] 23 [/SUP], Brian A Bergmark[SUP] 24 [/SUP], Jospeh Ebinger[SUP] 25 [/SUP], Tareq Alyousef[SUP] 26 [/SUP], Houman Khalili[SUP] 27 [/SUP], Chao-Wei Hwang[SUP] 28 [/SUP], Joshua Purow[SUP] 29 [/SUP], Alexander Llanos[SUP] 29 [/SUP], Brent McGrath[SUP] 30 [/SUP], Mark Tannenbaum[SUP] 31 [/SUP], Jon Resar[SUP] 32 [/SUP], Rodrigo Bagur[SUP] 33 [/SUP], Pedro Cox-Alomar[SUP] 34 [/SUP], Ada C Stefanescu Schmidt[SUP] 35 [/SUP], Lindsey A Cilia[SUP] 35 [/SUP], Farouc A Jaffer[SUP] 35 [/SUP], Michael Gharacholou[SUP] 36 [/SUP], Michael Salinger[SUP] 37 [/SUP], Brian Case[SUP] 7 [/SUP], Ameer Kabour[SUP] 38 [/SUP], Xuming Dai[SUP] 39 [/SUP], Osama Elkhateeb[SUP] 40 [/SUP], Taisei Kobayashi[SUP] 41 [/SUP], Hahn-Ho Kim[SUP] 42 [/SUP], Mazen Roumia[SUP] 43 [/SUP], Frank V Aguirre[SUP] 44 [/SUP], Jeffrey Rade[SUP] 45 [/SUP], Aun-Yeong Chong[SUP] 46 [/SUP], Hurst M Hall[SUP] 47 [/SUP], Shy Amlani[SUP] 48 [/SUP], Alireza Bagherli[SUP] 49 [/SUP], Rajan A G Patel[SUP] 50 [/SUP], David A Wood[SUP] 51 [/SUP], Frederick G Welt[SUP] 52 [/SUP], Jay Giri[SUP] 53 [/SUP], Ehtisham Mahmud[SUP] 54 [/SUP], Timothy D Henry[SUP] 55 [/SUP], Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council
Affiliations
- PMID: 33888249
- DOI: 10.1016/j.jacc.2021.02.055
Abstract
Background: 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).
Objectives: 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.
Methods: 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.
Results: 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).
Conclusions: 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.