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.

Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America

“…12 , 20 , 29 , 30 Rare cases of acute myocardial infarction with high thrombus burden were reported in patients with COVID-19 and may have also contributed to ventricular dysfunction and, in some cases, cardiogenic shock. 31 , 32 , 33 Additionally, due to reports of SARS-CoV-2 preceding autoimmune and autoinflammatory conditions such as multisystem inflammatory syndrome in children (MIS-C) and adults (MIS-A), the role of infection leading to an immune response against self-epitopes has also been invoked. 34 , 35 , 36 , 37 Secondarily, respiratory dysfunction and hypoxemia, as well as dysregulation of the renin-angiotensin-aldosterone system (RAAS), likely also contribute to cardiac findings in patients with COVID-19.…”

Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression

“…The diagnosis of myocardial injury in patients with COVID-19 with diagnostic imaging techniques was not described in published works of literature. However, cardiac biomarkers including highly sensitive Cardiac troponin I (hs-troponin I), creatinine kinase–myocardial band (CK-MB), myoglobin, and NT-natriuretic peptide were extensively described in the published literature [ [21] , [22] , [23] , [42] , [43] , [44] , [45] , [46] , [47] , [48] ].…”

COVID-19 and its Cardiac and Neurological Complications among Ontario Visible Minorities

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global pandemic now known as coronavirus disease (COVID- 19). (1,2) Data from outside Canada suggest there are substantial disparities among different ethnic groups in who gets infected and who have adverse outcomes.…”

“…(13) However, the racial distribution in the impact of COVID-19 in Canada has not been studied systematically. (2,10,19) In Ontario and based on the 2016 Canadian census, Chinese accounts for 19.4% while South Asians accounts for 29.6% of visible minorities. (43) Therefore, these two ethnic groups account for almost 50% of visible minorities in Ontario.…”