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

Santiago Garcia, Minneapolis Heart Institute Foundation
Payam Dehghani, Prairie Vascular Research
Cindy Grines, Northside Cardiovascular Institute
Laura Davidson, Northwestern University Feinberg School of Medicine
Keshav R. Nayak, Scripps Mercy Hospital
Jacqueline Saw, Vancouver General Hospital
Ron Waksman, MedStar Washington Hospital Center
John Blair, University of Chicago
Bagai Akshay, St. Michael's Hospital, Toronto
Ross Garberich, Minneapolis Heart Institute Foundation
Christian Schmidt, Minneapolis Heart Institute Foundation
Hung Q. Ly, University of Montreal
Scott Sharkey, Minneapolis Heart Institute Foundation
Nestor Mercado, University of New Mexico
Carlos E. Alfonso, University of Miami
Naoki Misumida, University of Kentucky
Deepak Acharya, University of Arizona Sarver Heart Center
Mina Madan, Sunnybrook Health Sciences Centre
Abdul Moiz Hafiz, Southern Illinois University
Nosheen Javed, Southcoast Health System
Jay Shavadia, Royal University Hospital, Saskatchewan Health
Jay Stone, Community Medical Center, RWJ Barnabas Health
M Chadi Alraies, DMC Harper University Hospital
Wah Htun, Gundersen Health System
William Downey, Sanger Heart and Vascular Institute, Atrium Health
Brian A. Bergmark, Brigham and Women's Hospital
Jospeh Ebinger, Cedars Sinai Heart Institute
Tareq Alyousef, Cook County Health and Hospitals System
Houman Khalili, Delray Medical Center

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.