TCT Connect 2020: Primary PCI is preferable in COVID-19 positive patients with ST-Elevation

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Tim Henry

Initial findings from the North American COVID-19 ST-Segment Elevation Myocardial Infarction (NACMI) registry, presented during a late breaking science session at TCT Connect 2020 (14–18 October, virtual), suggest that primary percutaneous coronary intervention (PCI) is preferable and feasible in COVID-19 positive patients, with ST-Segment Elevation.

The registry is a collaboration between the Society for Cardiovascular Angiography and Interventions (SCAI) and Canadian Association of Interventional Cardiology (CAIC), as well as the American College of Cardiology (ACC), chaired by Tim Henry (The Christ Hospital Medical, Cincinnati, USA) and Payam Dehghani (University of Saskatchewan, Regina, Saskatchewan, Canada). Henry presented initial findings from the registry at TCT Connect.

“COVID 19 has been particularly disruptive to cardiovascular practices. Patients with COVID 19 have increased mortality, we know that 15‒28% of patients admitted to the hospital have elevated troponin,” Henry said. “At the same time there has been a 30‒50% reduction in STEMI activation in cardiovascular admissions and in particular COVID 19 patients who present with ST-elevation present a particularly unique and challenge patient population.”

So far the registry has enrolled over 171 COVID-19 positive patients and 423 persons under investigation (PUI) with ST-segment elevation or new-onset left bundle branch block with a clinical correlate of myocardial ischaemia (chest pain, dyspnoea, cardiac arrest, haemodynamic instability) from 64 active sites, Henry explained.

Of the patients analysed, Henry said, ST-Elevation occurred more frequently in black, Hispanic and diabetic patients, adding that COVID-19 positive patients were more likely to present with cardiogenic shock—but not cardiac arrest—with lower left ventricle ejection fraction, more atypical symptoms, and slightly higher in-hospital presentation.

COVID-19 positive patients with ST-Elevation were more likely to not receive angiography (21%) and to receive medical therapy but still 71% received primary PCI, and lytics were uncommon. There were no differences in culprit vessel, and similar door to balloon times, he noted, adding that COVID-19 positive patients with ST-Elevation had higher in-hospital mortality and in-hospital stroke with longer length of stay.

Henry said: “COVID-19 positive patients definitely represent a unique and high-risk patient population. Primary PCI is preferable and feasible in COVID-19 positive patients, with door-to-balloon times similar to PUI [patients under investigation] or COVID-19 negative patients. That supports the updated COVID-19-specific STEMI guidelines that were put out by SCAI [Society for Cardiovascular Angiography and Intervention], ACC [American College of Cardiology] and American College of Emergency Physicians.”

Henry added that enrolment into the registry is continuing and urged greater participation from centres across North America, including Mexico.


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