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Trends in Outcomes of STEMI Patients With COVID-19
Quick Takes
- Compared to the first year of the pandemic (2020–prevaccine), COVID-19–positive STEMI patients in 2021 were more likely to be Caucasian with less respiratory signs and symptoms.
- Presence of cardiogenic shock and in-hospital mortality was significantly lower among vaccinated patients in 2021 compared to 2020. Unvaccinated patients continued to have high mortality regardless of year.
- There was increased utilization of invasive management of COVID-19–positive STEMI patients over the course of the pandemic.
Study Questions:
What are trends in outcomes among patients with coronavirus disease 2019 (COVID-19) and ST-segment elevation myocardial infarction (STEMI) over the course of the pandemic?
Methods:
The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. The investigators compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020–December 2020; Y2020) versus those treated in the second year (January 2021–December 2021; Y2021).
Results:
A total of 586 COVID-19–positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients’ characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs. 39%; p < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs. 51%; p = 0.04), and patients were less likely to have shock pre–percutaneous coronary intervention (13% vs. 18%; p = 0.07) or pulmonary manifestations (33% vs. 47%; p = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (p = 0.008). In Y2021, none of the 22 vaccinated patients expired in the hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (p = 0.009).
Conclusions:
Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.
Perspective:
The current retrospective analysis from the North America COVID-19 STEMI registry shows changes in clinical characteristics and outcomes among STEMI patients with COVID-19 infection over the course of the pandemic. Compared to the first year of the pandemic (2020–prevaccine), COVID-19–positive STEMI patients in 2021 were less likely to have respiratory symptoms and cardiogenic shock, resulting in overall lower mortality (relative 25% reduction). However, mortality remained high among the unvaccinated, suggesting benefit of vaccination. In addition, there was increased utilization of invasive management of COVID-19–positive STEMI patients over the course of the pandemic.
Clinical Topics: Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Acute Heart Failure, Interventions and Vascular Medicine, Chronic Angina
Keywords: COVID-19, Hospital Mortality, Myocardial Infarction, Myocardial Ischemia, Outcome Assessment, Health Care, Percutaneous Coronary Intervention, Respiratory Insufficiency, Secondary Prevention, Shock, Cardiogenic, ST Elevation Myocardial Infarction, Vaccination
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