Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19

Santiago Garcia; Payam Dehghani; Larissa Stanberry; Cindy Grines; Rajan A G Patel; Keshav R Nayak; Avneet Singh; Wah Wah Htun; Ameer Kabour; Nima Ghasemzadeh; Cristina Sanina; Joseph Aragon; M Chadi Alraies; Catherine Benziger; Brynn Okeson; Ross Garberich; Frederick G Welt; Laura Davidson; Abdul Moiz Hafiz; Deepak Acharya; Jay Stone; Aditya Mehra; Shy Amlani; Ehtisham Mahmud; Jay Giri; Mehmet Yildiz; Timothy D Henry

doi:10.1016/j.jacc.2022.03.345

Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19

J Am Coll Cardiol. 2022 Jun 7;79(22):2236-2244. doi: 10.1016/j.jacc.2022.03.345. Epub 2022 Apr 4.

Authors

Santiago Garcia¹, Payam Dehghani², Larissa Stanberry³, Cindy Grines⁴, Rajan A G Patel⁵, Keshav R Nayak⁶, Avneet Singh⁷, Wah Wah Htun⁸, Ameer Kabour⁹, Nima Ghasemzadeh¹⁰, Cristina Sanina¹¹, Joseph Aragon¹², M Chadi Alraies¹³, Catherine Benziger¹⁴, Brynn Okeson³, Ross Garberich³, Frederick G Welt¹⁵, Laura Davidson¹⁶, Abdul Moiz Hafiz¹⁷, Deepak Acharya¹⁸, Jay Stone¹⁹, Aditya Mehra²⁰, Shy Amlani²¹, Ehtisham Mahmud²², Jay Giri²³, Mehmet Yildiz²⁴, Timothy D Henry²⁵

Affiliations

¹ Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA. Electronic address: santiagogarcia@me.com.
² Prairie Vascular Research Inc, Regina, Saskatchewan, Canada.
³ Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
⁴ Northside Cardiovascular Institute, Atlanta, Georgia, USA; Society for Cardiovascular Angiography and Interventions (SCAI), Washington, DC, USA.
⁵ Ochsner Medical Center, New Orleans, Louisiana, USA.
⁶ Department of Cardiology Scripps Mercy Hospital, San Diego, California, USA.
⁷ North Shore University Hospital and Long Island Jewish Medical Center (NS/LIJ), Zucker School of Medicine at Hofstra, Queens, New York, USA.
⁸ Gundersen Health System, La Crosse, Wisconsin, USA.
⁹ Mercy St. Vincent's Medical Center, Toledo, Ohio, USA.
¹⁰ Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia, USA.
¹¹ Montefiore Medical Center and Albert Einstein College of Medicine, New York, New York, USA.
¹² Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
¹³ Detroit Medical Center, Detroit, Michigan, USA.
¹⁴ Essentia Health, Duluth, Minnesota, USA.
¹⁵ American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA; University of Utah Health Sciences, Salt Lake City, Utah, USA.
¹⁶ Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
¹⁷ Southern Illinois University School of Medicine, Springfield, Illinois, USA.
¹⁸ University of Arizona Sarver Heart Center, Tucson, Arizona, USA.
¹⁹ Community Medical Center (RWJ Barnabas Health), Toms River, New Jersey, USA.
²⁰ Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, New Jersey, USA.
²¹ William Osler Health System-Brampton, Brampton, Ontario, Canada.
²² University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla, California, USA.
²³ University of Pennsylvania, Philadelphia, Pennsylvania, USA. Electronic address: https://twitter.com/jaygirimd.
²⁴ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
²⁵ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA. Electronic address: https://twitter.com/HenrytTimothy.

Abstract

Background: We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic.

Objectives: The purpose of this study was to describe trends of COVID-19 patients with STEMI during 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. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021).

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-PCI (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 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.

Keywords: COVID-19; STEMI; heart attack; outcomes.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Hospital Mortality
Humans
Percutaneous Coronary Intervention*
Prospective Studies
ST Elevation Myocardial Infarction* / diagnosis
ST Elevation Myocardial Infarction* / epidemiology
ST Elevation Myocardial Infarction* / therapy