Initial Findings From the North American COVID-19 Myocardial Infarction Registry.
Initial Findings From the North American COVID-19 Myocardial Infarction Registry.
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DOI：
10.1016/j.jacc.2021.02.055
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发表时间：
2021-04-27
影响因子：
24
通讯作者：
Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council
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文献类型：
--
作者：
Garcia S;Dehghani P;Grines C;Davidson L;Nayak KR;Saw J;Waksman R;Blair J;Akshay B;Garberich R;Schmidt C;Ly HQ;Sharkey S;Mercado N;Alfonso CE;Misumida N;Acharya D;Madan M;Hafiz AM;Javed N;Shavadia J;Stone J;Alraies MC;Htun W;Downey W;Bergmark BA;Ebinger J;Alyousef T;Khalili H;Hwang CW;Purow J;Llanos A;McGrath B;Tannenbaum M;Resar J;Bagur R;Cox-Alomar P;Stefanescu Schmidt AC;Cilia LA;Jaffer FA;Gharacholou M;Salinger M;Case B;Kabour A;Dai X;Elkhateeb O;Kobayashi T;Kim HH;Roumia M;Aguirre FV;Rade J;Chong AY;Hall HM;Amlani S;Bagherli A;Patel RAG;Wood DA;Welt FG;Giri J;Mahmud E;Henry TD;Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council
2019 年冠状病毒病 (COVID-19) 大流行影响了 ST 段抬高型心肌梗死 (STEMI) 护理的许多方面，包括及时获得直接经皮冠状动脉介入治疗 (PPCI)。 NACMI（北美 COVID-19 和 STEMI）登记处的目标是描述患有 STEMI 的 COVID-19 患者的人口特征、管理策略和结果。在 3 个心脏病学会的指导下创建了一个前瞻性、持续的观察登记册。已确诊的 COVID+（第 1 组）或疑似（接受调查者 [PUI]）（第 2 组）COVID-19 感染的 STEMI 患者纳入其中。一组在新冠肺炎之前（2015年至2019年）接受治疗的年龄和性别匹配的STEMI患者（与新冠肺炎+患者以2:1的比例匹配）作为比较治疗策略和结果的对照组（第3组）。主要结局是院内死亡、中风、复发性心肌梗死或重复计划外血运重建的复合结果。截至 2020 年 12 月 6 日，NACMI 登记处已纳入 1,185 名患者（230 名 COVID+ 患者、495 名 PUI 患者和 460 名对照患者）。 COVID+ 患者更有可能是少数族裔（西班牙裔 23%，黑人 24%），并且糖尿病患病率较高 (46%)（相对于 PUI，所有 p < 0.001）。 COVID+ 患者更有可能出现心源性休克 (18%)，但接受侵入性血管造影的可能性较小 (78%)（相对于对照患者，所有 p < 0.001）。在接受血管造影的 COVID+ 患者中，71% 接受了 PPCI，20% 接受了药物治疗（相对于对照患者，p < 0.001）。主要结局发生在 36% 的 COVID+ 患者、13% 的 PUI 和 5% 的对照患者中（相对于对照患者，p < 0.001）。患有 STEMI 的 COVID+ 患者是具有独特人口和临床特征的高危患者群体。 PPCI 是可行的，并且仍然是主要的再灌注策略，支持当前的建议。
The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.
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