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
Kite, Thomas A
Ludman, Peter F
Gale, Chris P
Wu, Jianhua
Caixeta, Adriano
Mansourati, Jacques
Sabate, Manel
Jimenez-Quevedo, Pilar
Candilio, Luciano
Sadeghipour, Parham
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Affiliation
University of Leicester; University of Birmingham; University of Leeds; Sandwell and West Birmingham NHS Trust
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Publication date
2021-05-25
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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.
Citation
Kite TA, Ludman PF, Gale CP, Wu J, Caixeta A, Mansourati J, Sabate M, Jimenez-Quevedo P, Candilio L, Sadeghipour P, Iniesta AM, Hoole SP, Palmer N, Ariza-Solé A, Namitokov A, Escutia-Cuevas HH, Vincent F, Tica O, Ngunga M, Meray I, Morrow A, Arefin MM, Lindsay S, Kazamel G, Sharma V, Saad A, Sinagra G, Sanchez FA, Roik M, Savonitto S, Vavlukis M, Sangaraju S, Malik IS, Kean S, Curzen N, Berry C, Stone GW, Gersh BJ, Gershlick AH; International COVID-ACS Registry Investigators. International Prospective Registry of Acute Coronary Syndromes in Patients With COVID-19. J Am Coll Cardiol. 2021 May 25;77(20):2466-2476.
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Article