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

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 Schmidt; 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; Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council

doi:10.1016/j.jacc.2021.02.055

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

J Am Coll Cardiol. 2021 Apr 27;77(16):1994-2003. doi: 10.1016/j.jacc.2021.02.055.

Authors

Santiago Garcia¹, Payam Dehghani², Cindy Grines³, Laura Davidson⁴, Keshav R Nayak⁵, Jacqueline Saw⁶, Ron Waksman⁷, John Blair⁸, Bagai Akshay⁹, Ross Garberich¹⁰, Christian Schmidt¹⁰, Hung Q Ly¹¹, Scott Sharkey¹⁰, Nestor Mercado¹², Carlos E Alfonso¹³, Naoki Misumida¹⁴, Deepak Acharya¹⁵, Mina Madan¹⁶, Abdul Moiz Hafiz¹⁷, Nosheen Javed¹⁸, Jay Shavadia¹⁹, Jay Stone²⁰, M Chadi Alraies²¹, Wah Htun²², William Downey²³, Brian A Bergmark²⁴, Jospeh Ebinger²⁵, Tareq Alyousef²⁶, Houman Khalili²⁷, Chao-Wei Hwang²⁸, Joshua Purow²⁹, Alexander Llanos²⁹, Brent McGrath³⁰, Mark Tannenbaum³¹, Jon Resar³², Rodrigo Bagur³³, Pedro Cox-Alomar³⁴, Ada C Stefanescu Schmidt³⁵, Lindsey A Cilia³⁵, Farouc A Jaffer³⁵, Michael Gharacholou³⁶, Michael Salinger³⁷, Brian Case⁷, Ameer Kabour³⁸, Xuming Dai³⁹, Osama Elkhateeb⁴⁰, Taisei Kobayashi⁴¹, Hahn-Ho Kim⁴², Mazen Roumia⁴³, Frank V Aguirre⁴⁴, Jeffrey Rade⁴⁵, Aun-Yeong Chong⁴⁶, Hurst M Hall⁴⁷, Shy Amlani⁴⁸, Alireza Bagherli⁴⁹, Rajan A G Patel⁵⁰, David A Wood⁵¹, Frederick G Welt⁵², Jay Giri⁵³, Ehtisham Mahmud⁵⁴, Timothy D Henry⁵⁵; Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council

Affiliations

¹ Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA. Electronic address: [email protected].
² Prairie Vascular Research, Regina, Saskatchewan, Canada.
³ Northside Cardiovascular Institute, Atlanta, Georgia, USA; Society for Cardiovascular Angiography and Interventions, Washington, DC, USA.
⁴ Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁵ Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA.
⁶ Vancouver General Hospital, Vancouver, British Columbia, Canada.
⁷ MedStar Washington Hospital Center, Washington, DC, USA.
⁸ University of Chicago, Chicago, Illinois, USA.
⁹ St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁰ Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA.
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.
¹⁶ Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹⁷ Southern Illinois University School of Medicine, Springfield, Illinois, USA.
¹⁸ Southcoast Health System, New Bedford, Massachusetts, USA.
¹⁹ Royal University Hospital, Saskatchewan Health, Saskatoon, Saskatchewan, Canada.
²⁰ Community Medical Center, RWJ Barnabas Health, Toms River, New Jersey, USA.
²¹ DMC Harper University Hospital, Detroit, Michigan, USA.
²² Gundersen Health System, La Crosse, Wisconsin, USA.
²³ Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA.
²⁴ TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²⁵ Cedars Sinai Heart Institute, Los Angeles, California, USA.
²⁶ Cook County Health and Hospitals System, Chicago, Illinois, USA.
²⁷ Delray Medical Center, Tenet Healthcare, Delray Beach, Florida, USA.
²⁸ Frederick Health Hospital, Frederick, Maryland, USA; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁹ Holy Cross Hospital, Fort Lauderdale, Florida, USA.
³⁰ Horizon Health Network, Saint John, New Brunswick, Canada.
³¹ Iowa Heart, West Des Moines, Iowa, USA.
³² Frederick Health Hospital, Frederick, Maryland, USA, and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
³³ London Health Sciences Centre, Western University, London, Ontario, Canada.
³⁴ Louisiana State University, New Orleans, Louisiana, USA.
³⁵ Massachusetts General Hospital, Boston, Massachusetts, USA.
³⁶ Mayo Clinic Jacksonville, Jacksonville, Florida, USA.
³⁷ Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.
³⁸ Mercy St. Vincent's Medical Center, Toledo, Ohio, USA.
³⁹ NewYork-Presbyterian Queens, Flushing, New York, USA.
⁴⁰ Nova Scotia Health, Halifax, Nova Scotia, Canada.
⁴¹ University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁴² St. Mary's General Hospital, Kitchener, Ontario, Canada.
⁴³ St. Vincent Hospital, Worcester, Massachusetts, USA.
⁴⁴ Prairie Heart Institute at HSHS St. John's Hospital, Springfield, Illinois, USA.
⁴⁵ UMass Memorial Medical Center, Worcester, Massachusetts, USA.
⁴⁶ University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁴⁷ UT Southwestern Medical Center, Dallas, Texas, USA.
⁴⁸ William Osler Health System, Brampton, Ontario, Canada.
⁴⁹ Windsor Regional Hospital, Windsor, Ontario, Canada.
⁵⁰ Ochsner Medical Center, New Orleans, Louisiana, USA.
⁵¹ Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada.
⁵² American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA; University of Utah Health Sciences, Salt Lake City, Utah, USA.
⁵³ University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: https://twitter.com/jaygirimd.
⁵⁴ Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California, USA.
⁵⁵ Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA. Electronic address: https://twitter.com/HenrytTimothy.

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.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
COVID-19 / epidemiology*
Canada / epidemiology
Female
Hospital Mortality
Hospitalization / statistics & numerical data
Humans
Male
Middle Aged
North America / epidemiology
Percutaneous Coronary Intervention / statistics & numerical data*
Prospective Studies
Recurrence
Registries / statistics & numerical data
Reoperation / statistics & numerical data
SARS-CoV-2*
ST Elevation Myocardial Infarction / diagnosis
ST Elevation Myocardial Infarction / epidemiology*
ST Elevation Myocardial Infarction / mortality
ST Elevation Myocardial Infarction / therapy
Stroke / epidemiology
Stroke / etiology
United States / epidemiology
Young Adult