Update on the north american covid-19 myocardial infarction (NACMI) registry

Background: The Coronavirus 2019 (COVID-19) pandemic has impacted ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). The goal of The North American COVID-19 and STEMI (NACMI) registry is to describe demographic characteristics, management strategies and outcomes of COVID-19 patients with STEMI. Methods: A prospective, ongoing observational registry was created under the guidance of 3 societies. STEMI patients with confirmed COVID + or suspected (person under investigation or PUI) COVID-19 infection were included. A group of age and sex matched STEMI patients (matched to COVID + in a 2:1 ratio) treated in the pre-COVID era (2015-2019) serves as the control group for comparison of treatment strategies and outcomes. The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction or repeat unplanned revascularization. Results: Current enrollment numbers is comprised of 1,507 patients NACMI (301 COVID +, 604 PUIs and 602 controls). COVID + patients were more likely to have minority ethnicity and have diabetes and undergo medical therapy as primary perfusion therapy (all p <0.001 relative to PUI). Among COVID + patients who received angiography, 71% received PPCI and 23% had no culprit vessels identified on angiography (both p <0.001 relative to controls). The primary outcome occurred in 36% of COVID +, 13% of PUI and 5% of control patients (p<0.001 relative to controls). For the Late Breaking presentation, we will update the numbers of enrolment, present new insights into the ethnic differences, explore patient characteristics in those with no culprit disease and hope to present preliminary results from the EKG and angiographic core lab. Conclusions: COVID + patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics and high in-hospital cardiac events.