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International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

Authors:	Thomas A Kite Peter F Ludman Chris P Gale Jianhua Wu Adriano Caixeta Jacques Mansourati Manel Sabate Pilar Jimenez-Quevedo Luciano Candilio Parham Sadeghipour Angel M Iniesta Stephen P Hoole Nick Palmer Albert Ariza-Solé Alim Namitokov Hector H Escutia-Cuevas Flavien Vincent Otilia Tica Anthony H Gershlick

Institution:	1. Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom;2. Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom;3. Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom;4. Division of Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil;5. Department of Cardiology, University Hospital of Brest and University of Western Brittany, Orphy, France;6. Cardiovascular Institute, Interventional Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain;7. Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain;8. Royal Free London NHS Foundation Trust, London, United Kingdom;9. Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran;10. Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain;11. Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom;12. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom;13. Intensive Cardiac Care Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain;14. Scientific Research Institute–Regional Clinical Hospital #1 NA Prof. S.V. Ochapovsky, Krasnodar, Russia;15. Department of Cardiology, Regional Hospital ISSSTE Puebla, Puebla, Mexico;p. CHU Lille, Institut C?ur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France;q. University of Oradea, Faculty of Medicine and Pharmacy, Department of Medical disciplines, Oradea, Romania;r. Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya;s. Peoples Friendship University of Russia, Hospital n?a V.V.Vinogradov, Moscow, Russia;t. Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom;u. Department of Cardiology, National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh;v. Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom;w. Cardiology Department, National Heart Institute, Cairo, Egypt;x. Birmingham City Hospital, SWBH NHS Trust, Birmingham, United Kingdom;y. Department of Cardiovascular Medicine, Zagazig University, Zagazig, Egypt;z. Cardiovascular Department, University of Trieste, Trieste, Italy;11. Cardiology Department, Presidio Ospedaliero, Sanremo, Italy;22. Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland;33. Cardiovascular Department, Manzoni Hospital, Lecco, Italy;44. University Clinic for Cardiology, Medical Faculty, Ss’ Cyrial and Methodius University, Skopje, Macedonia;55. University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom;66. Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom;77. Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom;88. Faculty of Medicine, University of Southampton, and University Hospital Southampton NHS Trust, Southampton, United Kingdom;99. British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom;1010. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA;1111. Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA

Abstract:	BackgroundPublished data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear.ObjectivesThe purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre–COVID-19 cohorts.MethodsFrom March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re–myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre–COVID-19 databases (MINAP Myocardial Ischaemia National Audit Project] 2019 and BCIS British Cardiovascular Intervention Society] 2018 to 2019).ResultsIn 144 ST-segment elevation myocardial infarction (STEMI) and 121 non–ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001).ConclusionsIn this multicenter international registry, COVID-19–positive ACS patients presented later and had increased in-hospital mortality compared with a pre–COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.

Keywords:	acute coronary syndrome cardiogenic shock COVID-19 non–ST-segment elevation myocardial infarction ST-segment elevation myocardial infarction ACS"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"acute coronary syndrome COVID-19"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"coronavirus disease 2019 MI"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"myocardial infarction NSTE-ACS"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"non–ST-segment elevation acute coronary syndrome N-STEMI"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"non–ST-segment elevation myocardial infarction PCI"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"percutaneous coronary intervention STEMI"} {"#name":"keyword" "$":{"id":"kwrd0100"} "$$":[{"#name":"text" "_":"ST-segment elevation myocardial infarction
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