TY - JOUR
T1 - International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19
AU - International COVID-ACS Registry Investigators
AU - Kite, Thomas A.
AU - Ludman, Peter F.
AU - Gale, Chris P.
AU - Wu, Jianhua
AU - Caixeta, Adriano
AU - Mansourati, Jacques
AU - Sabate, Manel
AU - Jimenez-Quevedo, Pilar
AU - Candilio, Luciano
AU - Sadeghipour, Parham
AU - Iniesta, Angel M.
AU - Hoole, Stephen P.
AU - Palmer, Nick
AU - Ariza-Solé, Albert
AU - Namitokov, Alim
AU - Escutia-Cuevas, Hector H.
AU - Vincent, Flavien
AU - Tica, Otilia
AU - Ngunga, Mzee
AU - Meray, Imad
AU - Morrow, Andrew
AU - Arefin, Md Minhaj
AU - Lindsay, Steven
AU - Kazamel, Ghada
AU - Sharma, Vinoda
AU - Saad, Aly
AU - Sinagra, Gianfranco
AU - Sanchez, Federico Ariel
AU - Roik, Marek
AU - Savonitto, Stefano
AU - Vavlukis, Marija
AU - Sangaraju, Shankar
AU - Malik, Iqbal S.
AU - Kean, Sharon
AU - Curzen, Nick
AU - Berry, Colin
AU - Stone, Gregg W.
AU - Gersh, Bernard J.
AU - Gershlick, Anthony H.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/5/25
Y1 - 2021/5/25
N2 - 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.
AB - 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.
KW - COVID-19
KW - ST-segment elevation myocardial infarction
KW - acute coronary syndrome
KW - cardiogenic shock
KW - non–ST-segment elevation myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85105569024&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2021.03.309
DO - 10.1016/j.jacc.2021.03.309
M3 - Article
C2 - 34016259
AN - SCOPUS:85105569024
SN - 0735-1097
VL - 77
SP - 2466
EP - 2476
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -