North American COVID-19 ST-Segment-Elevation Myocardial Infarction (NACMI) registry: Rationale, design, and implications
North American COVID-19 ST-Segment-Elevation Myocardial Infarction (NACMI) registry: Rationale, design, and implications
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DOI：
10.1016/j.ahj.2020.05.006
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发表时间：
2020-09-01
影响因子：
4.8
通讯作者：
Henry, Timothy D.
中科院分区：
文献类型：
--
作者：
Dehghani, Payam;Davidson, Laura J.;Henry, Timothy D.
背景：引起2019年冠状病毒病(新冠肺炎)的新型冠状病毒--严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)已引起全球大流行。有心血管危险因素或既有心血管疾病的患者更有可能经历严重或危重的新冠肺炎疾病，而心肌损伤是关键的肺外表现。这些患者由于多种原因经常在心电图上出现ST段抬高，包括梗阻、非梗阻和/或血管造影正常的冠状动脉。ST段抬高心肌梗死的发生率与新冠肺炎阳性的住院患者相似，与发病率和死亡率的关系尚不清楚。了解以ST段抬高为表现的新冠肺炎患者的自然病史和适当的处理对于指导患者管理决策和保护医护人员是至关重要的。方法美国心血管造影与干预学会和加拿大介入心脏病学会与美国心脏病学会介入理事会合作，创建了一个多中心观察登记系统。这一登记将纳入确诊的新冠肺炎患者和临床怀疑心肌缺血的心电图新ST段抬高或新发左束支传导阻滞患者(PUI)。我们将使用倾向匹配将这些患者的人口统计学、临床结果、结果和管理与来自中西部STEMI联盟的15,000多名连续STEMI激活患者的历史对照组进行比较。主要的临床结果将是住院期间的主要心血管不良事件(MACE)，MACE的定义是所有原因的死亡率、中风、复发的MI以及在新冠肺炎确诊或PUI中重复的计划外血管重建。次要结果将包括：ST段抬高的病因报告；因心肌梗死、心脏骤停和/或休克而导致的心血管死亡；主要结果的个别组成部分；1年后的综合主要结果；以及心电图和血管造影特征。结论多中心NACMI登记中心将收集新冠肺炎患者的心电图ST段抬高的数据，以确定病因和相关的临床结果。建立、完善和推广这一登记册的协作和速度是未来研究工作的模板。
Background The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. Patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness and myocardial injury is a key extra-pulmonary manifestation. These patients frequently present with ST-elevation on an electrocardiogram (ECG) due to multiple etiologies including obstructive, non-obstructive, and/or angiographically normal coronary arteries. The incidence of ST-elevation myocardial infarction (STEMI) mimics in COVID-19-positive hospitalized patients, and the association with morbidity and mortality is unknown. Understanding the natural history and appropriate management of COVID-19 patients presenting with ST elevation is essential to inform patient management decisions and protect healthcare workers.Methods The Society for Cardiovascular Angiography and Interventions (SCAI) and The Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council have collaborated to create a multi-center observational registry, NACMI. This registry will enroll confirmed COVID-19 patients and persons under investigation (PUI) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the ECG with clinical suspicion of myocardial ischemia. We will compare demographics, clinical findings, outcomes and management of these patients with a historical control group of over 15,000 consecutive STEMI activation patients from the Midwest STEMI Consortium using propensity matching. The primary clinical outcome will be in-hospital major adverse cardiovascular events (MACE) defined as composite of all-cause mortality, stroke, recurrent MI, and repeat unplanned revascularization in COVID-19 confirmed or PUI. Secondary outcomes will include the following: reporting of etiologies of ST Elevation; cardiovascular mortality due to myocardial infarction, cardiac arrest and /or shock; individual components of the primary outcome; composite primary outcome at 1 year; as well as ECG and angiographic characteristics.Conclusion The multicenter NACMI registry will collect data regarding ST elevation on ECG in COVID-19 patients to determine the etiology and associated clinical outcomes. The collaboration and speed with which this registry has been created, refined, and promoted serves as a template for future research endeavors.