North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality

Payam Dehghani; Christian W Schmidt; Santiago Garcia; Brynn Okeson; Cindy L Grines; Avneet Singh; Rajan A G Patel; Jose Wiley; Wah Wah Htun; Keshav R Nayak; M Chadi Alraies; Nima Ghasemzadeh; Laura J Davidson; Deepak Acharya; Jay Stone; Tareq Alyousef; Brian C Case; Xuming Dai; Abdul Moiz Hafiz; Mina Madan; Faoruc A Jaffer; Jay S Shavadia; Ross Garberich; Akshay Bagai; Jyotpal Singh; Herbert D Aronow; Nestor Mercado; Timothy D Henry

doi:10.1016/j.jscai.2022.100404

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality

J Soc Cardiovasc Angiogr Interv. 2022 Sep-Oct;1(5):100404. doi: 10.1016/j.jscai.2022.100404. Epub 2022 Jul 9.

Authors

Payam Dehghani¹, Christian W Schmidt², Santiago Garcia², Brynn Okeson², Cindy L Grines³, Avneet Singh⁴, Rajan A G Patel⁵, Jose Wiley⁶, Wah Wah Htun⁷, Keshav R Nayak⁸, M Chadi Alraies⁹, Nima Ghasemzadeh¹⁰, Laura J Davidson¹¹, Deepak Acharya¹², Jay Stone¹³, Tareq Alyousef¹⁴, Brian C Case¹⁵, Xuming Dai¹⁶, Abdul Moiz Hafiz¹⁷, Mina Madan¹⁸, Faoruc A Jaffer¹⁹, Jay S Shavadia²⁰, Ross Garberich², Akshay Bagai²¹, Jyotpal Singh¹, Herbert D Aronow²², Nestor Mercado²³, Timothy D Henry²⁴

Affiliations

¹ Prairie Vascular Research Inc, Regina, Saskatchewan, Canada.
² Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
³ Northside Cardiovascular Institute, Atlanta, Georgia.
⁴ Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York.
⁵ Ochsner Medical Center, New Orleans, Louisiana.
⁶ Albert Einstein College of Medicine, Montefiore Health System, New York, New York.
⁷ Gundersen Health System, La Crosse, Wisconsin.
⁸ Department of Cardiology, Scripps Mercy Hospital, San Diego, California.
⁹ DMC Harper University Hospital, Detroit, Michigan.
¹⁰ Georgia Heart Institute, Gainesville, Georgia.
¹¹ Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
¹² University of Arizona Sarver Heart Center, Tucson, Arizona.
¹³ Community Medical Center (RWJ Barnabas Health), Toms River, New Jersey.
¹⁴ Cook County Health and Hospitals System, Chicago, Illinois.
¹⁵ MedStar Washington Hospital Center, Washington, District of Columbia.
¹⁶ NewYork-Presbyterian Queens, Flushing, New York.
¹⁷ Southern Illinois University School of Medicine, Springfield, Illinois.
¹⁸ Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
¹⁹ Massachusetts General Hospital, Boston, Massachusetts.
²⁰ Royal University Hospital (Saskatchewan Health), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
²¹ St. Michael's Hospital, Toronto, Ontario, Canada.
²² Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island.
²³ University of New Mexico, Albuquerque, New Mexico.
²⁴ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio.

Abstract

Background: In-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI.

Methods: Baseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient.

Results: In-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ², P < .001), and the model demonstrated good discriminative power (c-statistic = 0.81) and calibration (Hosmer-Lemeshow, P = .40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high-risk score categories, respectively).

Conclusions: The risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

Keywords: COVID-19; NACMI, North American COVID-19 Myocardial Infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TIMI, Thrombolysis in Myocardial Infarction; mortality; myocardial infarction; risk score.