Dataset Information

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

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.

SUBMITTER: Dehghani P

PROVIDER: S-EPMC9270689 | biostudies-literature | 2022 Sep-Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Dehghani Payam P Schmidt Christian W CW Garcia Santiago S Okeson Brynn B Grines Cindy L CL Singh Avneet A Patel Rajan A G RAG Wiley Jose J Htun Wah Wah WW Nayak Keshav R KR Alraies M Chadi MC Ghasemzadeh Nima N Davidson Laura J LJ Acharya Deepak D Stone Jay J Alyousef Tareq T Case Brian C BC Dai Xuming X Hafiz Abdul Moiz AM Madan Mina M Jaffer Faoruc A FA Shavadia Jay S JS Garberich Ross R Bagai Akshay A Singh Jyotpal J Aronow Herbert D HD Mercado Nestor N Henry Timothy D TD

Journal of the Society for Cardiovascular Angiography & Interventions 20220709 5

<h4>Background</h4>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.<h4>Methods</h4>Baseline demographic, clinical, and procedural data from patients in ...[more]

PMID: 35845345

Similar Datasets

Project description:BackgroundThe 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).ObjectivesThe 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.MethodsA 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.ResultsAs 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).ConclusionsCOVID+ 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.

Project description:ImportanceThere has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19.ObjectiveTo compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection.Design, setting, and participantsRetrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80 449).ExposuresActive COVID-19 infection present during the same encounter.Main outcomes and measuresThe primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year.ResultsThe out-of-hospital STEMI group included 76 434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001).Conclusions and relevanceAmong patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.

Project description:IntroductionWhile the CURB-65 score predicts mortality in community-acquired pneumonia (CAP), its performance in COVID-19 CAP is suboptimal. Hyperglycaemia correlates with an increased mortality in COVID-19. This analysis aims to enhance predictive accuracy for in-hospital mortality among COVID-19 patients by augmenting the CURB-65 score with objective variables, including markers of dysglycaemia.DesignA single-centre retrospective observational analysis assessed the effectiveness of the CURB-65 score in predicting in-hospital mortality among adult patients with moderate to severe COVID-19 from March to September 2020. Using a binary logistic regression model, two extended CURB-65 scores which include markers of dysglycemia are proposed to enhance the predictive capability of the CURB-65 score for in-hospital mortality.ResultsAmong 517 patients admitted, 117 (22.6%) died. Using the CURB-65 score, 393 patients (76%) were classified as low risk, 91 (17.6%) as medium risk and 33 (6.4%) as high risk. 37 patients were diagnosed with new-onset dysglycaemia, of which 22 (59.5%) died (p<0.001). Of those with dysglycaemia who died, 41% and 23% were classified as low risk and high risk using the CURB-65 score. The CURB-65 score demonstrated a modest area under the receiver operator characteristic curve (AUC) of 0.75 (95% CI 0.70 to 0.81) for in-hospital mortality in COVID-19 CAP. An Extended CURB-65 Score 1, incorporating an admission of fasting plasma glucose (FPG) and neutrophil to lymphocyte ratio, showed improved prognostic performance with an AUC of 0.80 (95% CI 0.76 to 0.85). When lactate and lactate dehydrogenase were added to these parameters (Extended CURB-65 Score 2), the AUC was 0.82 (95% CI 0.78 to 0.86). The integrated discrimination index showed an 11% and 24% higher discrimination slope when using the Extended CURB-65 Scores 1 and 2, respectively.ConclusionsThe addition of common biochemical parameters including an admission FPG enhances the prognostic performance of CURB-65 for in-hospital mortality among patients with COVID-19.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets