tetano
Editor, Senior Moderator
J Am Coll Cardiol
. 2021 May 25;77(20):2466-2476.
doi: 10.1016/j.jacc.2021.03.309.
International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
Thomas A Kite[SUP] 1 [/SUP], Peter F Ludman[SUP] 2 [/SUP], Chris P Gale[SUP] 3 [/SUP], Jianhua Wu[SUP] 3 [/SUP], Adriano Caixeta[SUP] 4 [/SUP], Jacques Mansourati[SUP] 5 [/SUP], Manel Sabate[SUP] 6 [/SUP], Pilar Jimenez-Quevedo[SUP] 7 [/SUP], Luciano Candilio[SUP] 8 [/SUP], Parham Sadeghipour[SUP] 9 [/SUP], Angel M Iniesta[SUP] 10 [/SUP], Stephen P Hoole[SUP] 11 [/SUP], Nick Palmer[SUP] 12 [/SUP], Albert Ariza-Sol?[SUP] 13 [/SUP], Alim Namitokov[SUP] 14 [/SUP], Hector H Escutia-Cuevas[SUP] 15 [/SUP], Flavien Vincent[SUP] 16 [/SUP], Otilia Tica[SUP] 17 [/SUP], Mzee Ngunga[SUP] 18 [/SUP], Imad Meray[SUP] 19 [/SUP], Andrew Morrow[SUP] 20 [/SUP], Md Minhaj Arefin[SUP] 21 [/SUP], Steven Lindsay[SUP] 22 [/SUP], Ghada Kazamel[SUP] 23 [/SUP], Vinoda Sharma[SUP] 24 [/SUP], Aly Saad[SUP] 25 [/SUP], Gianfranco Sinagra[SUP] 26 [/SUP], Federico Ariel Sanchez[SUP] 27 [/SUP], Marek Roik[SUP] 28 [/SUP], Stefano Savonitto[SUP] 29 [/SUP], Marija Vavlukis[SUP] 30 [/SUP], Shankar Sangaraju[SUP] 31 [/SUP], Iqbal S Malik[SUP] 32 [/SUP], Sharon Kean[SUP] 33 [/SUP], Nick Curzen[SUP] 34 [/SUP], Colin Berry[SUP] 35 [/SUP], Gregg W Stone[SUP] 36 [/SUP], Bernard J Gersh[SUP] 37 [/SUP], Anthony H Gershlick[SUP] 38 [/SUP], International COVID-ACS Registry Investigators
Affiliations
Abstract
Background: Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear.
Objectives: The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre-COVID-19 cohorts.
Methods: From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re-myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre-COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019).
Results: In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001).
Conclusions: In this multicenter international registry, COVID-19-positive ACS patients presented later and had increased in-hospital mortality compared with a pre-COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.
Keywords: COVID-19; ST-segment elevation myocardial infarction; acute coronary syndrome; cardiogenic shock; non?ST-segment elevation myocardial infarction.
. 2021 May 25;77(20):2466-2476.
doi: 10.1016/j.jacc.2021.03.309.
International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
Thomas A Kite[SUP] 1 [/SUP], Peter F Ludman[SUP] 2 [/SUP], Chris P Gale[SUP] 3 [/SUP], Jianhua Wu[SUP] 3 [/SUP], Adriano Caixeta[SUP] 4 [/SUP], Jacques Mansourati[SUP] 5 [/SUP], Manel Sabate[SUP] 6 [/SUP], Pilar Jimenez-Quevedo[SUP] 7 [/SUP], Luciano Candilio[SUP] 8 [/SUP], Parham Sadeghipour[SUP] 9 [/SUP], Angel M Iniesta[SUP] 10 [/SUP], Stephen P Hoole[SUP] 11 [/SUP], Nick Palmer[SUP] 12 [/SUP], Albert Ariza-Sol?[SUP] 13 [/SUP], Alim Namitokov[SUP] 14 [/SUP], Hector H Escutia-Cuevas[SUP] 15 [/SUP], Flavien Vincent[SUP] 16 [/SUP], Otilia Tica[SUP] 17 [/SUP], Mzee Ngunga[SUP] 18 [/SUP], Imad Meray[SUP] 19 [/SUP], Andrew Morrow[SUP] 20 [/SUP], Md Minhaj Arefin[SUP] 21 [/SUP], Steven Lindsay[SUP] 22 [/SUP], Ghada Kazamel[SUP] 23 [/SUP], Vinoda Sharma[SUP] 24 [/SUP], Aly Saad[SUP] 25 [/SUP], Gianfranco Sinagra[SUP] 26 [/SUP], Federico Ariel Sanchez[SUP] 27 [/SUP], Marek Roik[SUP] 28 [/SUP], Stefano Savonitto[SUP] 29 [/SUP], Marija Vavlukis[SUP] 30 [/SUP], Shankar Sangaraju[SUP] 31 [/SUP], Iqbal S Malik[SUP] 32 [/SUP], Sharon Kean[SUP] 33 [/SUP], Nick Curzen[SUP] 34 [/SUP], Colin Berry[SUP] 35 [/SUP], Gregg W Stone[SUP] 36 [/SUP], Bernard J Gersh[SUP] 37 [/SUP], Anthony H Gershlick[SUP] 38 [/SUP], International COVID-ACS Registry Investigators
Affiliations
- PMID: 34016259
- DOI: 10.1016/j.jacc.2021.03.309
Abstract
Background: Published data suggest worse outcomes in acute coronary syndrome (ACS) patients and concurrent coronavirus disease 2019 (COVID-19) infection. Mechanisms remain unclear.
Objectives: The purpose of this study was to report the demographics, angiographic findings, and in-hospital outcomes of COVID-19 ACS patients and compare these with pre-COVID-19 cohorts.
Methods: From March 1, 2020 to July 31, 2020, data from 55 international centers were entered into a prospective, COVID-ACS Registry. Patients were COVID-19 positive (or had a high index of clinical suspicion) and underwent invasive coronary angiography for suspected ACS. Outcomes were in-hospital major cardiovascular events (all-cause mortality, re-myocardial infarction, heart failure, stroke, unplanned revascularization, or stent thrombosis). Results were compared with national pre-COVID-19 databases (MINAP [Myocardial Ischaemia National Audit Project] 2019 and BCIS [British Cardiovascular Intervention Society] 2018 to 2019).
Results: In 144 ST-segment elevation myocardial infarction (STEMI) and 121 non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients, symptom-to-admission times were significantly prolonged (COVID-STEMI vs. BCIS: median 339.0 min vs. 173.0 min; p < 0.001; COVID NSTE-ACS vs. MINAP: 417.0 min vs. 295.0 min; p = 0.012). Mortality in COVID-ACS patients was significantly higher than BCIS/MINAP control subjects in both subgroups (COVID-STEMI: 22.9% vs. 5.7%; p < 0.001; COVID NSTE-ACS: 6.6% vs. 1.2%; p < 0.001), which remained following multivariate propensity analysis adjusting for comorbidities (STEMI subgroup odds ratio: 3.33 [95% confidence interval: 2.04 to 5.42]). Cardiogenic shock occurred in 20.1% of COVID-STEMI patients versus 8.7% of BCIS patients (p < 0.001).
Conclusions: In this multicenter international registry, COVID-19-positive ACS patients presented later and had increased in-hospital mortality compared with a pre-COVID-19 ACS population. Excessive rates of and mortality from cardiogenic shock were major contributors to the worse outcomes in COVID-19 positive STEMI patients.
Keywords: COVID-19; ST-segment elevation myocardial infarction; acute coronary syndrome; cardiogenic shock; non?ST-segment elevation myocardial infarction.