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

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. © 2021 American College of Cardiology Foundation

Kite T.A.1 , Ludman P.F.3 , Gale C.P.4 , Wu J.4 , Caixeta A.5 , Mansourati J.6 , Sabate M.7 , Jimenez-Quevedo P.8 , Candilio L.9 , Sadeghipour P.10 , Iniesta A.M.11 , Hoole S.P.12 , Palmer N.13 , Ariza-Solé A.14 , Namitokov A.15 , Escutia-Cuevas H.H.16 , Vincent F.17 , Tica O.18 , Ngunga M.19 , Meray I. 20 , Morrow A.21 , Arefin M.M.22 , Lindsay S.23 , Kazamel G.24 , Sharma V.25 , Saad A.26 , Sinagra G.27 , Sanchez F.A.28 , Roik M.29 , Savonitto S.30 , Vavlukis M.31 , Sangaraju S.32 , Malik I.S.33 , Kean S.34 , Curzen N.35 , Berry C.21, 36 , Stone G.W.37 , Gersh B.J.38 , Gershlick A.H.1 , International COVID-ACS Registry Investigators
Elsevier Science Publishing Company, Inc.
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  • 1 Department of Cardiovascular Sciences and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester
  • 2 University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
  • 3 Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
  • 4 Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, and the Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
  • 5 Division of Cardiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 6 Department of Cardiology, University Hospital of Brest and University of Western Brittany, Orphy, France
  • 7 Cardiovascular Institute, Interventional Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
  • 8 Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
  • 9 Royal Free London NHS Foundation Trust, London, United Kingdom
  • 10 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
  • 11 Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
  • 12 Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
  • 13 Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
  • 14 Intensive Cardiac Care Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
  • 15 Scientific Research Institute–Regional Clinical Hospital #1 NA Prof. S.V. Ochapovsky, Krasnodar, Russian Federation
  • 16 Department of Cardiology, Regional Hospital ISSSTE Puebla, Puebla, Mexico
  • 17 CHU Lille, Institut Cœur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
  • 18 University of Oradea, Faculty of Medicine and Pharmacy, Department of Medical disciplines, Oradea, Romania
  • 19 Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
  • 20 Peoples Friendship University of Russia, Hospital n∖a V.V.Vinogradov, Moscow, Russian Federation
  • 21 Department of Cardiology, Golden Jubilee National Hospital, Clydebank, United Kingdom
  • 22 Department of Cardiology, National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh
  • 23 Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
  • 24 Cardiology Department, National Heart Institute, Cairo, Egypt
  • 25 Birmingham City Hospital, SWBH NHS Trust, Birmingham, United Kingdom
  • 26 Department of Cardiovascular Medicine, Zagazig University, Zagazig, Egypt
  • 27 Cardiovascular Department, University of Trieste, Trieste, Italy
  • 28 Cardiology Department, Presidio Ospedaliero, Sanremo, Italy
  • 29 Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
  • 30 Cardiovascular Department, Manzoni Hospital, Lecco, Italy
  • 31 University Clinic for Cardiology, Medical Faculty, Ss’ Cyrial and Methodius University, Skopje, North Macedonia
  • 32 University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
  • 33 Cardiology Department, Imperial College Healthcare Trust, London, United Kingdom
  • 34 Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
  • 35 Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Trust, Southampton, United Kingdom
  • 36 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
  • 37 The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
  • 38 Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
acute coronary syndrome; cardiogenic shock; COVID-19; non–ST-segment elevation myocardial infarction; ST-segment elevation myocardial infarction
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