Are COVID-19 Patients With STEMI at Increased Risk of Mortality, Stroke?

COVID-19 patients with ST-segment elevation myocardial infarction (STEMI) are a high-risk population with unique demographic and clinical characteristics resulting in an increased risk of mortality and stroke, according to the initial findings from the North American COVID-19 Myocardial Infarction (NACMI) registry, published April 19 in the Journal of the American College of Cardiology.

Under the guidance of the ACC Interventional Council, Canadian Society of Interventional Cardiology and the Society for Cardiovascular Angiography and Interventions, the NACMI registry sought to define baseline characteristics and management strategies and outcome data for COVID-19 patients presenting with STEMI.

The registry enrolled 1,185 patients presenting with ST-segment elevation at 64 sites in the U.S. and Canada. The registry includes three groups of patients: patients with confirmed COVID-19 infection; patients with suspected COVID-19 infection; and a matched control group from a large STEMI registry.

"Our findings indicate that Black and Hispanic [COVID-19 positive] patients and those with diabetes mellitus more frequently presented with STEMI. [COVID-19 positive] patients with ST elevation have a very high in-hospital mortality rate of 33%," said Santiago Garcia, MD, FACC, lead author of the study. "Fortunately, most patients received primary percutaneous coronary intervention with very small treatment delays (≅ 15 min) despite the pandemic."

Results showed that many patients presented with respiratory symptoms rather than chest pain, and 18% of patients presented with cardiogenic shock, which likely contributes to the high fatality rate. The study also showed that 23% of patients had no clear culprit artery and may represent different reasons for ST-segment elevation including microthrombi, myocarditis or takotsubo cardiomyopathy.

"One of the striking observations of the NACMI registry is that the patients with COVID-19 look very different than any other STEMI population seen in this registry (i.e., the patients under investigation for COVID-19 and the control group) or any other North American STEMI registry; for example, the percentage of Blacks and Hispanic/Latino Americans among patients in the STEMI group with COVID-19 is exceptionally high (47%)," write Ran Kornowski, MD, FACC, and Katia Orvin, MD, in an accompanying editorial comment. "This finding may imply that STEMI care in the presence of COVID-19 may disproportionally affect minority groups and that future focus of care should be directed to a double challenge: addressing unique aspects of STEMI with COVID-19 and economic and social issues associated with STEMI in minority populations."

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Acute Heart Failure, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging, Chronic Angina

Keywords: ST Elevation Myocardial Infarction, Shock, Cardiogenic, Takotsubo Cardiomyopathy, Hospital Mortality, African Americans, Minority Groups, Myocarditis, Control Groups, Time-to-Treatment, Pandemics, COVID-19, Myocardial Infarction, Percutaneous Coronary Intervention, Chest Pain, Registries, Hispanic Americans, Diabetes Mellitus, Stroke, Arteries, Angiography, SARS-CoV-2

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