NACMI: Unique Registry Collaboration Aims to Improve Outcomes, Management of STEMI Patients With COVID-19

Patients with ST-Elevation and confirmed COVID-19 (COVID+) represent a unique and high-risk patient population with more frequent hospitalizations and greater risk of mortality, based on early findings from the North American COVID Myocardial Infarction (NACMI) Registry presented Oct. 14 during TCT 2020. According to Timothy D. Henry, MD, FACC, et al., the registry – a unique collaboration between the Society for Cardiovascular Angiography and Interventions, Canadian Association of Interventional Cardiology, the ACC Interventional Section Leadership Council and the Midwest STEMI Consortium – may play an important role in improving outcomes and management for these patients.

The NACMI Registry currently includes nearly 600 patients from 64 sites across the U.S. and Canada who presented with STEMI or new left bundle branch block (LBBB) on ECG and who were also COVID+ (N=171) or under investigation for COVID. Researchers compared demographics, clinical outcomes and management strategies between COVID+ patients and those under investigation, as well as propensity matched NACMI Registry patients against a historical control group of patients from the Midwest STEMI Consortium. The primary outcome was in-hospital major adverse cardiac events (MACE) and secondary outcomes included one-year MACE, individual components of MACE, and ECG and angiographic characteristics.

Key findings showed COVID+ patients had higher in-hospital mortality and in-hospital stroke with longer length of stay compared with those under investigation for COVID, or those in the historical control group. Additionally, ST-Elevation occurred more frequently in Blacks, Hispanics and diabetic COVID+ patients, compared with the other two groups. Researchers also noted that COVID+ patients with ST-Elevation were also more likely to present with atypical symptoms, as well as cardiogenic shock (but not cardiac arrest) with lower left ventricular ejection fraction. They were also more likely to receive medical therapy vs. angiography. Henry noted the findings support primary PCI as both preferable and feasible in COVID+ patients, with door-to-balloon times similar across all groups.

“The NACMI Registry is not only the largest registry of its type, but it is also demonstrative of how the cardiovascular community continues to come together to solve for critical problems facing cardiovascular patients with COVID-19,” said Henry. “Future directions for the registry include ongoing enrollment, targeted expansion into COVID-19 hot spots, and continued research into long-term outcomes, as well as racial/ethnic and regional differences.”

Clinical Topics: COVID-19 Hub, Stable Ischemic Heart Disease, Vascular Medicine, Chronic Angina

Keywords: TCT20, Transcatheter Cardiovascular Therapeutics, ST Elevation Myocardial Infarction, COVID-19, severe acute respiratory syndrome coronavirus 2, Myocardial Infarction

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