North American COVID-19 STEMI Research Reveals High Mortality and Atypical Symptoms

April 20, 2021 – The Minneapolis Heart Institute Foundation (MHIF) announced the first publication of outcomes from the North American COVID-19 ST-Segment Elevation Myocardial Infarction (STEMI) Registry (NACMI). The first data published in the Journal of the American College of Cardiology (JACC) this week shows that COVID-positive patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics that are important to consider in providing optimal care.[1] The data show patients with STEMI and COVID-19 carries a poor prognosis, with 1 in 3 patients dying.

Important key findings include:
• Minorities were disproportionally affected: nearly 50 percent of the STEMI patients had minority ethnicity (23 percent Hispanic; 24 percent Black)
• In-hospital mortality was high: 33 percent (4% for controls without COVID)
• Symptoms were unique: majority (54 percent) presented with respiratory symptoms (shortness of breath) rather than chest pain
• Significant proportion of COVID-positive patients presented with high-risk STEMI: cardiogenic shock (18 percent) and cardiac arrest (11 percent), which may explain the high fatality rate
• Primary angioplasty remained the dominant revascularization modality during the pandemic with small treatment delays (at about 15 minutes).

At the start of the COVID-19 pandemic, the management of STEMI patients with confirmed or suspected COVID infection was controversial, as some experts were advocating for pharmacological reperfusion (thrombolytic therapy) to protect essential healthcare workers and resources. That strategy is associated with delays in reperfusion, increased mortality and risk of heart failure.

“This research has provided critical insights into the care of STEMI patients during the COVID-19 pandemic and has revealed the importance of understanding demographic and clinical factors that are unique and different from what has historically been seen in patients prior to the pandemic,” said Santiago Garcia, M.D., interventional cardiologist, researcher and primary investigator for MHIF, which is the international coordinating center for the study. “This extensive research registry is an effort from 64 sites across North America that have worked to compile data, share insights and inform outcomes in patients as we treat heart attacks that continue to happen during this pandemic. We’ve learned that the signs and symptoms are different while the importance of prompt treatment with primary percutaneous coronary intervention (PPCI) remains a standard of care that is critical to maintain good outcomes for STEMI patients, including minority populations who may not present initially with common symptoms.”

Among COVID-positive patients who received angiography, 71 percent received PPCI and 20 percent received medical therapy. The primary endpoint was a composite of in-hospital death, stroke, recurrent myocardial infarction (MI) or unplanned revascularization and occurred in 36 percent of COVID-positive patients, 13 percent of persons under investigation for COVID-19 (PUIs) and 4 percent of control patients.

The registry underscores that PPCI (the current recommendation for STEMI) is feasible, but the reality is the combination of STEMI and COVID-19 carries a poor prognosis, with 1 in 3 patients succumbing to the disease, even among those treated with state-of-the-art invasive angiography (28 percent mortality).

NACMI is the largest STEMI registry in patients with confirmed or suspected COVID-19 infection. The present analysis included patients from 64 clinical sites from across the U.S. and Canada. A total of 1,185 patients were included in this first report: 230 COVID-positive STEMI patients, 495 STEMI patients suspected but ultimately confirmed not to have COVID-19, and 460 age- and sex-matched control STEMI patients treated prior to the pandemic. The comparative group was pulled from the existing Midwest STEMI Consortium, which is a large (>15,000), prospective multi-center registry of consecutive STEMI patients for which MHIF is the data coordinating center.

The NACMI registry is a collaborative effort between the Society for Cardiovascular Angiography and Interventions (SCAI) and the Canadian Association of Interventional Cardiology (CAIC). It is a research study designed to collect data on COVID-19 positive patients or persons under investigation (suspected to have COVID-19 infection) with STEMI, a serious heart attack involving a blockage in one of the heart's major arteries.

About Minneapolis Heart Institute Foundation

The Minneapolis Heart Institute Foundation (MHIF) is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education. MHIF is a recognized leader across all specialties of heart and vascular research. Each year, MHIF leads more than 200 research studies with more than 2,200 patients and publishes more than 200 articles to share learnings from research. MHIF research has improved the standard of care around the world through protocols like Level One for heart attack, which significantly improved outcomes and survival for patients.

For more information: mplsheart.org