Initial Findings From the North American COVID-19 Myocardial Infarction Registry |
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| Authors: | 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 Timothy D. Henry |
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| Affiliation: | 1. Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA;2. Prairie Vascular Research, Regina, Saskatchewan, Canada;3. Northside Cardiovascular Institute, Atlanta, Georgia, USA;4. Society for Cardiovascular Angiography and Interventions, Washington, DC, USA;5. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;6. Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA;7. Vancouver General Hospital, Vancouver, British Columbia, Canada;8. MedStar Washington Hospital Center, Washington, DC, USA;9. University of Chicago, Chicago, Illinois, USA;10. St. Michael’s Hospital, Toronto, Ontario, Canada;11. University of Montreal, Montreal, Quebec, Canada;12. University of New Mexico, Albuquerque, New Mexico, USA;13. University of Miami, Miami, Florida, USA;14. University of Kentucky, Lexington, Kentucky, USA;15. University of Arizona Sarver Heart Center, Tucson, Arizona, USA;p. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;q. Southern Illinois University School of Medicine, Springfield, Illinois, USA;r. Southcoast Health System, New Bedford, Massachusetts, USA;s. Royal University Hospital, Saskatchewan Health, Saskatoon, Saskatchewan, Canada;t. Community Medical Center, RWJ Barnabas Health, Toms River, New Jersey, USA;u. DMC Harper University Hospital, Detroit, Michigan, USA;v. Gundersen Health System, La Crosse, Wisconsin, USA;w. Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA;x. TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA;y. Cedars Sinai Heart Institute, Los Angeles, California, USA;z. Cook County Health and Hospitals System, Chicago, Illinois, USA;11. Delray Medical Center, Tenet Healthcare, Delray Beach, Florida, USA;22. Frederick Health Hospital, Frederick, Maryland, USA;33. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;44. Holy Cross Hospital, Fort Lauderdale, Florida, USA;55. Horizon Health Network, Saint John, New Brunswick, Canada;66. Iowa Heart, West Des Moines, Iowa, USA;77. Frederick Health Hospital, Frederick, Maryland, USA, and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;88. London Health Sciences Centre, Western University, London, Ontario, Canada;99. Louisiana State University, New Orleans, Louisiana, USA;1010. Massachusetts General Hospital, Boston, Massachusetts, USA;1111. Mayo Clinic Jacksonville, Jacksonville, Florida, USA;1212. Medical College of Wisconsin, Wauwatosa, Wisconsin, USA;1313. Mercy St. Vincent’s Medical Center, Toledo, Ohio, USA;1414. NewYork-Presbyterian Queens, Flushing, New York, USA;1515. Nova Scotia Health, Halifax, Nova Scotia, Canada;pp. University of Pennsylvania, Philadelphia, Pennsylvania, USA;qq. St. Mary’s General Hospital, Kitchener, Ontario, Canada;rr. St. Vincent Hospital, Worcester, Massachusetts, USA;ss. Prairie Heart Institute at HSHS St. John''s Hospital, Springfield, Illinois, USA;tt. UMass Memorial Medical Center, Worcester, Massachusetts, USA;uu. University of Ottawa Heart Institute, Ottawa, Ontario, Canada;vv. UT Southwestern Medical Center, Dallas, Texas, USA;ww. William Osler Health System, Brampton, Ontario, Canada;xx. Windsor Regional Hospital, Windsor, Ontario, Canada;yy. Ochsner Medical Center, New Orleans, Louisiana, USA;zz. Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada;111. American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA;222. University of Utah Health Sciences, Salt Lake City, Utah, USA;333. Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California, USA;444. Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA |
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| Abstract: | BackgroundThe 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).ObjectivesThe 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.MethodsA 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.ResultsAs 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).ConclusionsCOVID+ 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. |
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