LB-11
Core-laboratory Angiographic Characteristics and Mortality of Patients with STEMI and COVID-19: Insights from the NACMI Registry
Presenter
Payam Dehghani, MD, Prairie Vascular Research Network, Regina, SK, Canada
Payam Dehghani, MD1, Jyotpal Singh, Ph.D.1, G.B. John Mancini, M.D.2, Larissa Stanberry, PhD3, Seth Bergstedt, M.Sc.3, Mina Madan, M.D., FSCAI4, Brian C Case, MD, FSCAI5, Rajan A. Patel, M.D., FSCAI6, Jay H. Stone, M.D., FSCAI7, Catherine Benziger, MD8, Nima Ghasemzadeh, MD FACC FSCAI9, Cindy L. Grines, M.D., MSCAI10, Jay Shavadia, MD11, Deepak Acharya, M.D., FSCAI12, Nosheen Javed, MD13, Anna Bortnick, M.D., Ph.D., FSCAI14, Jose M. Wiley, M.D., FSCAI15, Rodrigo Bagur, M.D., Ph.D., FSCAI16, Ross Garberich, MS, MBA17, Santiago Garcia, M.D., FSCAI18 and Timothy D. Henry, M.D., MSCAI19, (1)Prairie Vascular Research Network, Regina, SK, Canada, (2)University of British Columbia, Vancouver, BC, Canada, (3)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (4)Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (5)MedStar Heart & Vascular Institute , Washington, DC, (6)Ochsner Clinic Foundation, New Orleans, LA, (7)Shore Cardiac Institute, Toms River, NJ, (8)Essentia Health, Duluth, MN, (9)Georgia Heart Institute, Gainesville, GA, (10)Northside Hospital Cardiovascular Institute, Johns Creek, GA, (11)University of Saskatchewan, Saskatoon, SK, Canada, (12)Banner - University Medical Center Tucson, Tucson, AZ, (13)Southcoast Health, Fall River, MA, (14)Montefiore Medical Center, Bronx, NY, (15)Tulane University School of Medicine, New Orleans, LA, (16)London Health Sciences Centre, London, ON, Canada, (17)Minneapolis Heart Institute Foundation, Minneapolis, MN, (18)The Christ Hospital Health Network, Cincinnati, OH, (19)The Christ Hospital Health Network, Covington, KY
Keywords: Acute Coronary Syndromes (ACS), COVID-19, Complications and Imaging & Physiology
Background
The SCAI-sponsored, North American COVID Myocardial Infarction (NACMI) Registry is the largest, prospective dataset of patients presenting with ST-elevation myocardial infarction (STEMI) and COVID-19 worldwide. We present the results of the independent angiographic core laboratory analysis.
Methods
For this pre-specified independent angiographic analysis, sites were invited to send angiograms to the Cardiovascular Imaging Research Core Lab (Vancouver, CA). Quantitative coronary angiography percent diameter stenosis (%DS), Thrombolysis In Myocardial Infarction (TIMI) flow, Myocardial Blush Grade (MBG) and Thrombus Grade Burden (TGB) were assessed.
Percutaneous coronary intervention (PCI) was classified as unsuccessful if there was residual DS >50% and/or <TIMI 2 flow and/or untreated complication(s). Multi-vessel (MV) thrombotic disease and stenotic disease was defined as TGB > 0 and DS
> 50% in
> 2 arteries, respectively.
Results
Angiograms of 241 patients from 17 sites (12 US, 5 CAN) were analyzed.
The Table displays baseline and post PCI angiographic findings. In-hospital mortality was 20%, with a relative risk [95% CI] of 4.42 [1.52, 10.2] for MV thrombotic disease, 2.26 [1.26, 4.01] for TGB of > 2, 2.84 [1.59, 5.19] for unsuccessful PCI, and 1.58 [0.876, 2.96] for MV stenotic disease.
Conclusions
Patients with COVID-19 and STEMI have unique and independently-verified angiographic findings, particularly high thrombus burden in multiple vascular territories leading to suboptimal reperfusion with PCI and higher risk of complications. These angiographic findings may contribute to the high mortality rate in these patients.
