Payam Dehghani, Chase J Ellingson, Jyotpal Singh, Ellen Cravero, G B John Mancini, Larissa Stanberry, Mina Madan, Catherine P Benziger, Nima Ghasemzadeh, Anna E Bortnick, Rohan Kankaria, Cindy L Grines, Keshav Nayak, Ehtisham Mahmud, Kevin R Bainey, M Chadi Alraies, Akshay Bagai, Rajan A G Patel, Shy Amlani, Brian C Case, Ron Waksman, Jay S Shavadia, Jay H Stone, Deepak Acharya, Nosheen Javed, Rodrigo Bagur, Ross Garberich, Santiago Garcia, Timothy D Henry
This study describes long-term outcomes in patients with STEMI and COVID-19. We demonstrate that the excess mortality risk associated with COVID-19 STEMI extends beyond the index hospitalization and exhibits a clear risk gradient. The cause is likely multifactorial, including pandemic-era disruptions in care, longer time-to-treatment, and the unique pathophysiology of COVID-19 STEMI.
BACKGROUND: Patients with COVID-19 and ST-elevation myocardial infarction (STEMI) from the North American COVID-19 Myocardial Infarction (NACMI) registry had elevated in-hospital mortality compared with COVID-19-negative patients and historical controls. We examined 1-year mortality outcomes from the NACMI registry.
METHODS: This was a substudy of NACMI centers that participated in long-term follow-up. Patients in the NACMI registry were stratified into COVID-19-positive and COVID-19-negative groups. A historical 2018-2019 control group was derived from the Midwest STEMI Consortium registry. The primary outcome was 1-year mortality.
RESULTS: A total of 2358 STEMI patients (30% female) were included in this study, divided into 3 subgroups: COVID-19-positive (n = 623), COVID-19-negative (n = 694), and historical controls (n = 1041). One-year mortality in COVID-19-positive patients was 45% (HR, 4.88; 95% CI, 3.73-6.39; P < .001), compared with 27% (HR, 3.93; 95% CI, 2.92-5.29; P < .001) in COVID-19-negative patients and 11% in matched controls (P < .001). Most deaths (86%) occurred during the index hospitalization, with a median time to death of 27 days (IQR 6, 343) in the COVID-19-positive group. Among survivors of index hospitalization, 1-year mortality was 12% (COVID-19-positive; HR, 2.20; 95% CI, 1.26-3.85; P = .006), 9.6% (COVID-19-negative; HR, 2.31; 95% CI, 1.26-4.21; P = .007), and 5.3% (controls) (P < .001).
CONCLUSIONS: This study describes long-term outcomes in patients with STEMI and COVID-19. We demonstrate that the excess mortality risk associated with COVID-19 STEMI extends beyond the index hospitalization and exhibits a clear risk gradient. The cause is likely multifactorial, including pandemic-era disruptions in care, longer time-to-treatment, and the unique pathophysiology of COVID-19 STEMI.