Greater adverse outcomes in patients presenting with COVID-19 and STEMI

Outcomes from the North American COVID-19 STEMI registry

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. 

Group 1: STEMI patients with confirmed COVID+
Group 2: suspected COVID-19 infection
Group 3: Control group that was age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) 

The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization.

Key findings of the NACMI Registry

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.

Read more: 
https://www.jacc.org/doi/10.1016/j.jacc.2021.02.055

Editorial Comment: 
https://www.jacc.org/doi/10.1016/j.jacc.2021.03.231