Dataset Information

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

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.

SUBMITTER: Garcia S

PROVIDER: S-EPMC8054772 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

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

Garcia Santiago S Dehghani Payam P Grines Cindy C Davidson Laura L Nayak Keshav R KR Saw Jacqueline J Waksman Ron R Blair John J Akshay Bagai B Garberich Ross R Schmidt Christian C Ly Hung Q HQ Sharkey Scott S Mercado Nestor N Alfonso Carlos E CE Misumida Naoki N Acharya Deepak D Madan Mina M Hafiz Abdul Moiz AM Javed Nosheen N Shavadia Jay J Stone Jay J Alraies M Chadi MC Htun Wah W Downey William W Bergmark Brian A BA Ebinger Jospeh J Alyousef Tareq T Khalili Houman H Hwang Chao-Wei CW Purow Joshua J Llanos Alexander A McGrath Brent B Tannenbaum Mark M Resar Jon J Bagur Rodrigo R Cox-Alomar Pedro P Stefanescu Schmidt Ada C AC Cilia Lindsey A LA Jaffer Farouc A FA Gharacholou Michael M Salinger Michael M Case Brian B Kabour Ameer A Dai Xuming X Elkhateeb Osama O Kobayashi Taisei T Kim Hahn-Ho HH Roumia Mazen M Aguirre Frank V FV Rade Jeffrey J Chong Aun-Yeong AY Hall Hurst M HM Amlani Shy S Bagherli Alireza A Patel Rajan A G RAG Wood David A DA Welt Frederick G FG Giri Jay J Mahmud Ehtisham E Henry Timothy D TD

Journal of the American College of Cardiology 20210401 16

<h4>Background</h4>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).<h4>Objectives</h4>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.<h4>Methods</h4>A prospective, ongoing observational registry was creat ...[more]

PMID: 33888249

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Project description:BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has exposed longstanding racial and ethnic inequities in health risks and outcomes in the United States. We aimed to identify racial and ethnic differences in presentation and outcomes for patients hospitalized with COVID-19.MethodsThe American Heart Association COVID-19 Cardiovascular Disease Registry is a retrospective observational registry capturing consecutive patients hospitalized with COVID-19. We present data on the first 7868 patients by race/ethnicity treated at 88 hospitals across the United States between January 17, 2020, and July 22, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (death, myocardial infarction, stroke, heart failure) and COVID-19 cardiorespiratory ordinal severity score (worst to best: death, cardiac arrest, mechanical ventilation with mechanical circulatory support, mechanical ventilation with vasopressors/inotrope support, mechanical ventilation without hemodynamic support, and hospitalization alone. Multivariable logistic regression analyses were performed to assess the relationship between race/ethnicity and each outcome adjusting for differences in sociodemographic, clinical, and presentation features, and accounting for clustering by hospital.ResultsAmong 7868 patients hospitalized with COVID-19, 33.0% were Hispanic, 25.5% were non-Hispanic Black, 6.3% were Asian, and 35.2% were non-Hispanic White. Hispanic and Black patients were younger than non-Hispanic White and Asian patients and were more likely to be uninsured. Black patients had the highest prevalence of obesity, hypertension, and diabetes. Black patients also had the highest rates of mechanical ventilation (23.2%) and renal replacement therapy (6.6%) but the lowest rates of remdesivir use (6.1%). Overall mortality was 18.4% with 53% of all deaths occurring in Black and Hispanic patients. The adjusted odds ratios for mortality were 0.93 (95% CI, 0.76-1.14) for Black patients, 0.90 (95% CI, 0.73-1.11) for Hispanic patients, and 1.31 (95% CI, 0.96-1.80) for Asian patients compared with non-Hispanic White patients. The median odds ratio across hospitals was 1.99 (95% CI, 1.74-2.48). Results were similar for major adverse cardiovascular events. Asian patients had the highest COVID-19 cardiorespiratory severity at presentation (adjusted odds ratio, 1.48 [95% CI, 1.16-1.90]).ConclusionsAlthough in-hospital mortality and major adverse cardiovascular events did not differ by race/ethnicity after adjustment, Black and Hispanic patients bore a greater burden of mortality and morbidity because of their disproportionate representation among COVID-19 hospitalizations.

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Dataset Information

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

Background

Objectives

Methods

Results

Conclusions

Publications

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

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