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

• DOI: 10.1016/j.jacc.2021.02.055
• Publication Date: 2021-04-20T00:39:29Z
• 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; 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...; 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
• Keywords: Adult; Male; Reoperation; Canada; Adolescent; Cardiology; Infectious Disease; outcomes; Percutaneous Coronary Intervention; Recurrence; Humans; Hospital Mortality; Prospective Studies; Registries; Original Investigation; Aged; Aged, 80 and over; SARS-CoV-2; COVID-19; Middle Aged; 3. Good health; Hospitalization; Cardiovascular Diseases; Virus Diseases; North America; ST Elevation Myocardial Infarction; Female; 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.