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.

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