Initial findings from the North American Cardiovascular COVID-19 Myocardial Infarction (NACMI) Registry have been published online in the Journal of the American College of Cardiology (JACC). NACMI is the largest prospective ST-segment elevation myocardial infarction (STEMI) COVID registry of its kind.
The registry sought to define baseline characteristics and management strategies and outcome data for COVID-19 positive patients presenting with STEMI. The results demonstrate COVID-19 positive patients with STEMI are a high-risk population with unique demographic and clinical characteristics resulting in an increased risk of mortality and stroke.
Under the guidance of the American College of Cardiology (ACC) Interventional Council, Canadian Association of Interventional Cardiology, and the Society for Cardiovascular Angiography & Interventions (SCAI), the registry enrolled 1,185 patients presenting with ST-segment elevation at 64 sites across the USA and Canada. Three groups of patients were included in the registry: COVID-19 positive patients; suspected positive or person under investigation, and; a matched control group from a large STEMI registry.
“Our findings indicate that Black and Hispanic COVID positive patients and those with diabetes mellitus more frequently presented with STEMI. COVID positive patients with ST elevation have a very high in-hospital mortality rate of 33%,” said Santiago Garcia, of the Minneapolis Heart Institute Foundation, Minneapolis, USA and lead author of the study. “Fortunately, most patients received primary percutaneous coronary intervention (PPCI) with very small treatment delays (≅ 15 min) despite the pandemic,” he continued.
Many patients presented with respiratory symptoms rather than chest pain, and cardiogenic shock was common (18%), 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.
“This is the largest registry of COVID positive patients presenting with STEMI. These results clearly illustrate the challenges and uniqueness of this patient population that deserves prompt and special attention. The rapid development of this ongoing, critically important prospective registry reflects the strong and unique collaboration of all three societies. It was gratifying to be part of this process and hopefully the results will improve the care of our patients and stimulate further research,” stated Timothy Henry, president-elect of SCAI and study chair.
Henry spoke to Cardiovascular News about the NACMI registry during a video interview in late 2020. You can watch the discussion below.