North American COVID-19 Myocardial Infarction (NACMI) Registry: One-Year Follow-Up
Presenter
Payam Dehghani, MD, Prairie Vascular Research Network, Regina, SK, Canada
Payam Dehghani, MD1, Chase J Ellingson, BKin2, Jyotpal Singh, PhD3, Ellen Cravero4, G.B. John Mancini, MD5, Larissa Stanberry, PhD6, Mina Madan, M.D., FSCAI7, Catherine Benziger, MD8, Nima Ghasemzadeh, MD FACC FSCAI9, Anna Bortnick, M.D., Ph.D., FSCAI10, Rohan Kankaria11, Cindy L. Grines, M.D., MSCAI12, Keshav R. Nayak, M.D., FSCAI13, Mehmet Yildiz14, M Chadi Alraies, MD, FSCAI15, Akshay Bagai16, Rajan A. Patel, M.D., FSCAI17, Shy Amlani, MD18, Brian C Case, MD, FSCAI19, Ron Waksman, M.D.20, Jay Shavadia, MD21, Jay H. Stone, M.D., FSCAI22, Deepak Acharya, M.D., FSCAI23, Nosheen Javed, MD24, Rodrigo Bagur, M.D., Ph.D.25, Ross Garberich, MS, MBA4, Santiago Garcia, MD, FSCAI14 and Timothy D. Henry, M.D., MSCAI26, (1)Prairie Vascular Research Network, Regina, SK, Canada, (2)The University of Saskatchewan, Regina, SK, CANADA, (3)Prairie Vascular Research Network, Regina, SK, CANADA, (4)Minneapolis Heart Institute Foundation, Minneapolis, MN, (5)University of British Columbia, Vancouver, BC, Canada, (6)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (7)Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (8)Essentia Health, Duluth, MN, (9)Georgia Heart Institute, Gainesville, GA, (10)Montefiore Health System, Bronx, NY, (11)Albert Einstein College of Medicine, The Bronx, NY, (12)Northside Hospital Heart Institute, Buford, GA, (13)Scripps Mercy Hospital, San Diego, CA, (14)The Christ Hospital Health Network, Cincinnati, OH, (15)Detroit Medical Center Heart Hospital, Bloomfield, MI, (16)St. Michael's Hospital, Toronto, ON, Canada, (17)The University of Virginia, Charlottesville, VA, (18)William Osler Health System, Toronto, ON, Canada, (19)MedStar Heart & Vascular Institute , Bethesda, MD, (20)MedStar Washington Hospital Center, Washington, DC, (21)University of Saskatchewan, Saskatoon, SK, Canada, (22)Shore Cardiac Institute, Toms River, NJ, (23)Banner - University Medical Center Tucson, Tucson, AZ, (24)Southcoast Health, Fall River, MA, (25)London Health Sciences Centre, London, ON, Canada, (26)The Christ Hospital Health Network, Dayton, KY
Keywords: Acute Coronary Syndromes (ACS), COVID-19 and Coronary
Background
Patients with COVID-19 and ST-elevation myocardial infarction (STEMI) from the North American COVID-19 Myocardial Infarction (NACMI) registry had 4-8-fold higher in-hospital mortality compared with STEMI-only historical controls. We examined one-year mortality outcomes from the NACMI registry.
Methods
This was a sub-study of high-enrollment NACMI centers that participated in long-term follow-up. Patients in the NACMI registry were stratified by COVID-19 status. A matched historical control group was derived from the Midwest STEMI Consortium. The primary outcome was one-year mortality, assessed using Kaplan-Meier curves.
Results
A total of 2358 STEMI patients (30% female) were included in this study, with three subgroups: COVID-19 positive (n=623), COVID-19 negative (n=694), and matched controls (n=1041). One-year mortality (Figure 1) in COVID-19 positive patients was 45%, compared with 27% in COVID-19 negative patients and 11% in matched controls (p<0.001). Most deaths (86%) occurred during the index hospitalization, with a median time to death of 27 days [IQR 6, 343]. Among survivors of index hospitalization, one-year mortality rates were 12% (COVID-19 positive), 9.6% (COVID-19 negative), and 5.3% (matched controls) (p<0.001).
Conclusions
This is the first study to describe long-term outcomes in patients with STEMI and COVID-19. One-year mortality was high and driven predominantly by deaths during the index hospitalization. Among patients who survived to hospital discharge, subsequent mortality remained higher than pre-pandemic controls, providing important prognostic information regarding risk beyond the acute phase. 