Infectious Disease

Unwanted results with simultaneous COVID-19, STEMI, increased

April 19, 2021

3 min read

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Garcia reports that he has received institutional research grants from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. served as a consultant for Boston Scientific and Medtronic; and has served as a Proctor for Edwards Lifesciences. In the study you will find all relevant financial information from all other authors. Kornowski and Orvin do not report any relevant financial information.

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Patients with STEMI and COVID-19 were less likely to have primary PCI and had more adverse outcomes than patients with pre-pandemic STEMI, researchers reported.

According to new data from the North American COVID-19 STEMI registry, underrepresented groups were more likely to test positive for COVID-19 when presented with STEMI.

Underrepresented Groups more likely to have STEMI and COVID-19 at the same time, and groups with COVID-19 are more likely to experience adverse hospital outcomes. The infographic content was adapted from Garcia S, et al. J Am Coll Cardiol. 2021; doi: 10.1016 / j.jacc.2021.02.055.

As Healio previously reported, initial results from the North American COVID-19 STEMI (NACMI) registry presented at the virtual TCT Connect showed a 30% to 50% reduction in patients with STEMI and other CV problems in the Hospital treated. The data, updated December 6, 2020, was published in the Journal of the American College of Cardiology.

“The NACMI registry was designed prospectively … as a researcher-initiated collaboration that includes three North American societies (Society for Cardiovascular Angiography and Interventions, Canadian Association for Interventional Cardiology, and Intervention Council of the American College of Cardiology) and 64 clinical sites. Date,” Santiago Garcia, MD, Associate Interventional Cardiologist at the Minneapolis Heart Institute and Associate Professor of Medicine at the University of Minnesota, and colleagues wrote. “Because we saw a significant decrease in cardiac catheterization lab activations for STEMI in the US at the onset of the COVID-19 pandemic, the NACMI registry was intentionally designed to allow all STEMI patients regardless of the modality of revascularization and the use of invasive angiography are recorded. “

For the present analysis, the researchers divided patients into patients with STEMI and confirmed COVID-19 (n = 230), patients with STEMI and suspected COVID-19 infection (n = 495), and age- and sex-matched patients with STEMI who treated from 2015 to 2019, which served as a control (n = 460). The primary outcome was a composite endpoint that included death, stroke, recurrent MI, or recurrent unplanned revascularization in the hospital.

The researchers observed that patients who tested positive for COVID-19 were mostly men (71%) and from an underrepresented group (23% Hispanic American; 24% Black; 6% Asian). White patients made up 39% of the patients who tested positive. Of the cohort that tested positive for COVID-19, 18% had cardiogenic shock and 11% had cardiac arrest.

Treatment and hospital outcomes

Among patients with STEMI and confirmed COVID-19, 78% had angiography and 71% of patients with angiography had primary PCI, compared to 93% of controls with primary PCI (P <0.001), while 20% of patients with STEMI and COVID -19, who had angiography performed, received medical therapy alone without reperfusion, compared with 2% of controls, according to the researchers.

In addition, in patients with primary PCI, the researchers observed slightly longer mean door-to-balloon times compared to controls in patients with confirmed COVID-19 (79 minutes versus 66 minutes; P = 0.008) and patients with suspected COVID-19 (77 minutes versus 66 minutes; P <0.001).

In addition, those who tested positive for COVID-19 were more likely that angiography did not identify a perpetrator vessel compared to the control group (23% vs. 1%; P <0.001) and those with suspected infection ( 23% vs. 11)%; P <0.001).

According to the researchers, the primary composite endpoint occurred in 36% of patients with confirmed COVID-19, 13% of patients with suspected COVID-19, and 5% of the control group (P <0.001 for both COVID-19 groups vs. controls) .

This association was mainly driven by in-hospital mortality (confirmed COVID-19, 33%; presumed COVID-19, 11%; controls, 4%; P for confirmed group versus other groups <0.001) and stroke (confirmed COVID-19 , 3%; suspected COVID-19, 2%; controls, 0%; P for confirmed vs. suspected patients <0.27; P for confirmed vs. controls = 0.03).

In patients with STEMI and COVID-19, mortality was higher in those who did not undergo coronary angiography than in those who did (48% versus 28%; P = 0.006).

The researchers reported that patients with confirmed COVID-19 had extended hospital and intensive care stays.

“Very diverse” population

“One of the notable observations made by the NACMI registry is that patients with COVID-19 look very different from any other STEMI population in this registry (i.e., the patients screened for COVID-19 and the control group) or any other north American STEMI Register; For example, the percentage of Black and Hispanic / Latino Americans among patients in the STEMI group with COVID-19 is exceptionally high (47%). ” Ran Kornowski, MD, and Katia Orvin, MD, from the Department of Cardiology at Rabin Medical Center in Petah Tikva and the Faculty of Medicine at Tel Aviv University, Israel, wrote in a related editorial. “This finding could mean that STEMI care in the presence of COVID-19 is disproportionately affecting minority groups and that the future focus of care should be on a twofold challenge: addressing unique aspects of STEMI with COVID-19 and the associated economic issues and social problems STEMI in minorities. “

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