Protocol Watch: Death Rates for Blacks & Hispanic COVID-19 Positive, STEMI Patients Significantly Higher

Protocol Watch Death Rates for Blacks & Hispanic COVID-19 Positive, STEMI Patients Significantly Higher

COVID-19 positive patients with ST-elevation myocardial infarction (STEMI) heart attacks experience worse in-hospital prospects for mortality and stroke as well as lengthier hospital stays, based on recent findings from a registry called the North American COVID-19 ST-Segment Elevation Myocardial Infarction (NACMI) Registry. With outcomes and observations presented recently at the 2020 virtual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, the findings are particularly bleak for Black and Brown Americans. Ethnic minorities, mainly African Americans and Hispanics (Latinx) represent over 50 percent COVID-19 positive patients with STEMI heart attacks. This is compared to a less than 10 percent figure reported in a heart attack registry (Midwest STEMI consortium—MSC) representing non-COVID-19 patients.

The Presenter

This data was recently presented on behalf of he NACMI study investigators by Timothy Henry, MD, president of the Society for Cardiac Angiography and Interventions (SCAI).

TrialSite provides a brief breakdown of this cardiovascular-focused registry study associated with the COVID-19 pandemic.

What is the basis for this Registry study?

Described in the peer-reviewed Elsevier Public Health Emergency Collection, the NACMI Registry was the result of the recognition that patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness; they observed that myocardial injury is a key extra-pulmonary manifestation of the novel coronavirus. As summarized in the journal, “These patients frequently present with ST-elevation on an electrocardiogram (ECG) due to multiple etiologies including obstructive, non-obstructive, and/or angiographically normal coronary arteries.” Because of these heightened risks the investigators sought it vital to investigate “the natural history and appropriate management of COVID-19 patients presenting with ST. elevation…essential to inform patient management decisions and protect healthcare workers.”

What organizations were involved in developing the multi-center registry?

The Society for Cardiovascular Angiography and Interventions (SCAI) and the Canadian Association of Interventional Cardiology (CAIC) in conjunction with the American College of Cardiology Interventional Council.

What Patients were enrolled in the registry?

The investigators enrolled patients confirmed with COVID-19 as well as those “persons under investigation (PUI) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the ECG with clinical suspicion of myocardial ischemia.”

The Study details

As reported in DAIC, the study currently includes 64 clinical sites across America and includes over 594 patients (171 COVID-positive; 423 PUI). The investigators expect to include up to 100 participating sites across both America and Canada.

Study Arms and what was the core study comparison?

The investigators then accumulated, analyzed and compared demographic, clinical findings, outcomes and management of the target patients with a historical control group consisting of over 15,000 from the Midwest STEMI Consortium using propensity matching.

Within the study, there were three groups including two groups associated with the NACMI Registry (Confirmed COVID-19 or PUI and STEMI or New LBBB) and one group associated with the Historical Cohort (propensity matched cohort from Midwest STEMI Consortium).

What Study Site served as a coordinating data center for NACMI and MSC?

The Minneapolis Heart Institute Foundation (MHIF) 

MHIF Primary Investigator Point of View

Santiago Garcia, MD, interventional cardiologist, MHIF research and primary investigator for MHIF recently shared his thoughts on the study via DAIC: “This effort is a collaboration between cardiovascular experts across North America to gather real time insights that can guide care and benefit patient outcomes during this pandemic.”

What is Dr. Garcia’s Position on the threat to minority groups?

Again in DAIC, Dr. Garcia declared that the findings thus far from the registry study reveals that “…heart attacks in COVID-19 positive patients disproportionately affect minorities and that traditional, standard-of-care interventions, including coronary angiography and primary angioplasty are used less often. This is a call to our colleagues to recognize that COVID-19 positive patients with ST-elevation represent a unique and high-risk patient population and we need to address with care protocols that will advance outcomes.”

Lead Research/Investigators

For a complete list, see the source link