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

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

Santiago Garcia et al. J Am Coll Cardiol. .

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.

Keywords: COVID-19; ST-segment myocardial infarction; outcomes.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by an American College of Cardiology Accreditation Grant, Saskatchewan Health Research Foundation (SHRF), and grants from Medtronic and Abbott Vascular to SCAI. Dr. Garcia has received institutional research grants from Edwards Lifesciences, BSCI, Medtronic, and Abbott Vascular; has served as a consultant for Medtronic and BSCI; and has served as a proctor for Edwards Lifesciences. Dr. Saw has received unrestricted research grant support from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, National Institutes of Health, AstraZeneca, Abbott Vascular, St. Jude Medical, Boston Scientific, and Servier; has received salary support from the Michael Smith Foundation for Health Research; has received speaker honoraria from AstraZeneca, Abbott Vascular, Boston Scientific, and Bayer; has received consultancy and advisory board honoraria from AstraZeneca, Boston Scientific, Abbott Vascular, Gore, Abiomed, and Baylis; and has received proctorship honoraria from Abbott Vascular and Boston Scientific. Dr. Jaffer has received research grants from Siemens, Canon, Shockwave, and Teleflex; has served as a consultant for Boston Scientific, Siemens, Biotronik, and Magenta Medical; owns equity interest in Intravascular Imaging; and Massachusetts General Hospital has patent licensing arrangements with Canon, Terumo, and Spectrawave, and Dr. Jaffer has a right to receive licensing royalties. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Initial Reperfusion Strategies in COVID+ Patients Undergoing Coronary Angiography Frequency distribution of reperfusion strategies and medical therapy in COVID+ patients. CABG = coronary artery bypass grafting; COVID = coronavirus disease; PPCI = primary percutaneous coronary intervention.
Figure 2
Figure 2
In-Hospital Outcomes Including Composite of In-Hospital Death, Stroke, Recurrent MI, or Unplanned Revascularization (Primary Outcome) and Its Individual Components Incidence (%) of major adverse cardiac events and length of intensive care unit (ICU) and hospital stay expressed as median and interquartile range (IQR). COVID-19 = coronavirus disease 2019; MI = myocardial infarction; PUI = person under investigation.
Central Illustration
Central Illustration
Summary of Key Findings of the NACMI Registry Acute myocardial infarction in patients with coronavirus disease 2019. COVID = coronavirus disease; MACE = major adverse cardiac events; NACMI = North American COVID-19 and STEMI; PUI = person under investigation.
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References

    1. Williamson E.J., Walker A.J., Bhaskaran K. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584:430–436. - PMC - PubMed
    1. Lala A., Johnson K.W., Januzzi J.L. Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection. J Am Coll Cardiol. 2020;76:533–546. - PMC - PubMed
    1. Sandoval Y., Januzzi J.L., Jr., Jaffe A.S. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC Review Topic of the Week. J Am Coll Cardiol. 2020;76:1244–1258. - PMC - PubMed
    1. Puntmann V.O., Carerj M.L., Wieters I. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19) JAMA Cardiol. 2020;5:1265–1273. - PMC - PubMed
    1. Stefanini G.G., Montorfano M., Trabattoni D. ST-elevation myocardial infarction in patients with COVID-19: clinical and angiographic outcomes. Circulation. 2020;141:2113–2116. - PMC - PubMed

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