NACMI: Hospital mortality rate in STEMI patients with COVID-19 decreased in 2021
Deaths among hospitalized patients who had COVID-19 and ST-segment elevation myocardial infarction (STEMI) were 25% lower in 2021 than in 2020, and no deaths occurred among STEMI patients who had been vaccinated against COVID -19, according to a study presented April 4 during ACC.22 and simultaneously published in the Journal of the American College of Cardiology .
Santiago García, MD, FACC, et al., used the North American COVID-19 STEMI Registry (NACMI) to compare the outcomes of 586 hospitalized patients who had both COVID-19 and a STEMI. Among them, 227 patients were treated in 2020 before COVID-19 vaccines were available, and 359 patients were treated in 2021 after COVID-19 vaccines received emergency use authorization from the U.S. Administration. US Food and Drugs
The primary endpoint of the study was in-hospital mortality, and the secondary endpoint was a composite of death, stroke, or repeat myocardial infarction (MI).
In 2021, 83 patients out of 359 (23%) died in hospital, compared to 75 out of 227 (33%) in 2020. Of the 359 patients treated in 2021, 90 (25%) died or suffered a stroke or recurrence. MI, compared to 80 of 227 patients (35%) treated in 2020.
- The risk of in-hospital death was 70% higher for patients who had pulmonary infiltrates, low blood pressure, or cardiogenic shock.
- Patients aged 66 or older and those with diabetes were also more likely to die in the hospital.
Vaccination data was available for 193 (54%) of the patients treated in 2021. Of these, 22 patients (11%) had been vaccinated and none died in hospital.
In contrast, 37 of the 171 unvaccinated patients (22%) died in the hospital, a hospital mortality rate considerably higher than the expected rate of around 4% - 6% for patients who have had a STEMI, according to García .
The researchers also found that vaccinated patients were much less likely to experience severe respiratory illness, providing "additional support for the value of COVID-19 vaccination in older adults."
"In 2020, before vaccines were available for COVID-19, we saw significantly more patients presenting to the hospital with shortness of breath as their primary symptom, rather than the more typical heart attack symptom of pain. in the chest," García said. "Having difficulty breathing, having an abnormal chest infection, even among patients who had STEMI.
Trends in clinical characteristics, management strategies and outcomes of STEMI patients with COVID-19
Background
We previously reported high in-hospital mortality for STEMI patients with COVID-19 treated in the early phase of the pandemic.
Goals
Describe trends in COVID-19 patients with STEMI over the course of the pandemic.
Methods
The North American COVID-19 STEMI Registry (NACMI) is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America.
We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (1/2020 to 12/2020) versus those treated in the second year (1/2021 to 12/2021).
Results
A total of 586 COVID positive (+) patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021.
Patient characteristics changed over time. Compared to 2020, the proportion of Caucasian patients was higher (58% vs. 39%, p<0.001), patients more frequently presented typical ischemic symptoms (59% vs. 51%, p=0.04) , were less likely to have pre-PCI shock (13% vs 18%, p=0.07) or pulmonary manifestations (33% vs 47%, p=0.001) in Y2021. Hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (p=0.008).
In Y2021, none of the 22 vaccinated patients died in hospital, while hospital death was recorded in 37 (22%) of the unvaccinated patients (p=0.009).
Conclusions
There have been significant changes in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection over the course of the pandemic.
