Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA.
Prairie Vascular Research, Regina, Saskatchewan, Canada.
J Am Coll Cardiol. 2021 Apr 27;77(16):1994-2003. doi: 10.1016/j.jacc.2021.02.055.
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.
2019 年冠状病毒病（COVID-19）大流行已经对 ST 段抬高型心肌梗死（STEMI）治疗的许多方面产生了影响，包括及时接受直接经皮冠状动脉介入治疗（PPCI）。
北美 COVID-19 和 STEMI 登记研究（NACMI）的目的是描述 COVID-19 合并 STEMI 患者的人口统计学特征、管理策略和结局。
在 3 个心脏病学会的指导下创建了一个前瞻性、正在进行的观察性登记研究。纳入确诊 COVID-19 阳性（第 1 组）或疑似（待调查患者[PUI]）（第 2 组）COVID-19 感染的 STEMI 患者。一组年龄和性别匹配的 STEMI 患者（与 COVID-19 阳性患者以 2:1 的比例匹配）作为比较治疗策略和结局的对照组（第 3 组）。主要结局是住院期间死亡、卒中和再发心肌梗死或重复计划外血运重建的复合终点。
截至 2020 年 12 月 6 日，NACMI 登记研究共纳入 1185 例患者（230 例 COVID-19 阳性患者、495 例 PUI 患者和 460 例对照组患者）。COVID-19 阳性患者更有可能为少数族裔（西班牙裔 23%，黑人 24%），且糖尿病患病率更高（46%）（与 PUI 患者相比，均 p<0.001）。COVID-19 阳性患者更有可能出现心源性休克（18%），但更不可能接受血管造影检查（78%）（与对照组患者相比，均 p<0.001）。在接受血管造影检查的 COVID-19 阳性患者中，71%接受了 PPCI，20%接受了药物治疗（与对照组患者相比，均 p<0.001）。COVID-19 阳性患者、PUI 患者和对照组患者的主要结局发生率分别为 36%、13%和 5%（与对照组患者相比，均 p<0.001）。
STEMI 合并 COVID-19 的患者代表了具有独特人口统计学和临床特征的高危患者群体。可行的 PPCI 仍然是主要的再灌注策略，支持目前的推荐意见。
