International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19

Kite, Thomas A., Ludman, Peter F., Gale, Chris P., Wu, Jianhua, Caixeta, Adriano, Mansourati, Jacques, Sabate, Manel, Jimenez-quevedo, Pilar, Candilio, Luciano, Sadeghipour, Parham, Iniesta, Angel M., Hoole, Stephen P., Palmer, Nick, Ariza-solé, Albert, Namitokov, Alim, Escutia-cuevas, Hector H., Vincent, Flavien, Tica, Otilia, Ngunga, Mzee, Meray, Imad, Morrow, Andrew, Arefin, Md Minhaj, Lindsay, Steven, Kazamel, Ghada, Sharma, Vinoda, Saad, Aly, Sinagra, Gianfranco, Sanchez, Federico Ariel, Roik, Marek, Savonitto, Stefano, Vavlukis, Marija, Sangaraju, Shankar, Malik, Iqbal S., Kean, Sharon, Curzen, Nick, Berry, Colin, Stone, Gregg W., Gersh, Bernard J. and Gershlick, Anthony H. (2021) International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19. Journal of the American College of Cardiology, 77 (20), 2466-2476. (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.

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Contributors

Author: Nick Curzen

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