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North American COVID-19 ST-Segment-Elevation Myocardial Infarction (NACMI) registry: Rationale, design, and implications.
American heart journal Pub Date : 2020-05-16 , DOI: 10.1016/j.ahj.2020.05.006 Payam Dehghani 1 , Laura J Davidson 2 , Cindy L Grines 3 , Keshav Nayak 4 , Jacqueline Saw 5 , Prashant Kaul 6 , Akshay Bagai 7 , Ross Garberich 8 , Christian Schmidt 8 , Hung Q Ly 9 , Jay Giri 10 , Perwaiz Meraj 11 , Binita Shah 12 , Santiago Garcia 13 , Scott Sharkey 8 , David A Wood 14 , Frederick G Welt 15 , Ehtisham Mahmud 16 , Timothy D Henry 17
American heart journal Pub Date : 2020-05-16 , DOI: 10.1016/j.ahj.2020.05.006 Payam Dehghani 1 , Laura J Davidson 2 , Cindy L Grines 3 , Keshav Nayak 4 , Jacqueline Saw 5 , Prashant Kaul 6 , Akshay Bagai 7 , Ross Garberich 8 , Christian Schmidt 8 , Hung Q Ly 9 , Jay Giri 10 , Perwaiz Meraj 11 , Binita Shah 12 , Santiago Garcia 13 , Scott Sharkey 8 , David A Wood 14 , Frederick G Welt 15 , Ehtisham Mahmud 16 , Timothy D Henry 17
Affiliation
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19), has resulted in a global pandemic. Patients with cardiovascular risk factors or established cardiovascular disease are more likely to experience severe or critical COVID-19 illness and myocardial injury is a key extra-pulmonary manifestation. 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. The incidence of ST-elevation myocardial infarction (STEMI) mimics in COVID-19-positive hospitalized patients, and the association with morbidity and mortality is unknown. Understanding the natural history and appropriate management of COVID-19 patients presenting with ST elevation is essential to inform patient management decisions and protect healthcare workers.
Methods
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 have collaborated to create a multi-center observational registry, NACMI. This registry will enroll confirmed COVID-19 patients and 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. We will compare demographics, clinical findings, outcomes and management of these patients with a historical control group of over 15,000 consecutive STEMI activation patients from the Midwest STEMI Consortium using propensity matching. The primary clinical outcome will be in- hospital major adverse cardiovascular events (MACE) defined as composite of all-cause mortality, stroke, recurrent MI, and repeat unplanned revascularization in COVID-19 confirmed or PUI. Secondary outcomes will include the following: reporting of etiologies of ST Elevation; cardiovascular mortality due to myocardial infarction, cardiac arrest and /or shock; individual components of the primary outcome; composite primary outcome at 1 year; as well as ECG and angiographic characteristics.
Conclusion
The multicenter NACMI registry will collect data regarding ST elevation on ECG in COVID-19 patients to determine the etiology and associated clinical outcomes. The collaboration and speed with which this registry has been created, refined, and promoted serves as a template for future research endeavors.
中文翻译:
北美 COVID-19 ST 段抬高型心肌梗死 (NACMI) 登记处:基本原理、设计和影响。
导致 2019 年冠状病毒病 (COVID-19) 的新型冠状病毒,即严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2),已导致全球大流行。患有心血管危险因素或已确诊心血管疾病的患者更有可能患上严重或危重的 COVID-19 疾病,而心肌损伤是关键的肺外表现。由于多种病因,包括阻塞性、非阻塞性和/或血管造影正常的冠状动脉,这些患者经常在心电图 (ECG) 上出现 ST 段抬高。ST 段抬高型心肌梗死 (STEMI) 的发病率与 COVID-19 阳性住院患者相似,其与发病率和死亡率的关系尚不清楚。了解 ST 段抬高的 COVID-19 患者的自然史和适当的治疗对于为患者管理决策提供信息并保护医护人员至关重要。方法 心血管血管造影和介入协会 (SCAI) 和加拿大介入心脏病学协会 (CAIC) 与美国心脏病学会介入委员会合作创建了一个多中心观察登记处 NACMI。该登记系统将招募确诊的 COVID-19 患者和接受调查者 (PUI),这些患者和心电图上出现新发 ST 段抬高或新发左束支传导阻滞 (LBBB) 且临床怀疑心肌缺血的患者。我们将使用倾向匹配将这些患者的人口统计数据、临床发现、结果和管理与来自中西部 STEMI 联盟的超过 15,000 名连续 STEMI 激活患者的历史对照组进行比较。主要临床结果将是院内主要不良心血管事件(MACE),定义为由全因死亡率、卒中、复发性心肌梗死和确诊的 COVID-19 或 PUI 中的重复计划外血运重建组成的综合结果。次要结果将包括以下内容: ST 段抬高病因的报告;由于心肌梗塞、心脏骤停和/或休克导致的心血管死亡;主要结果的各个组成部分;1 年复合主要结局;以及心电图和血管造影特征。结论 多中心 NACMI 登记处将收集有关 COVID-19 患者心电图 ST 段抬高的数据,以确定病因和相关临床结果。该注册表创建、完善和推广的协作和速度可以作为未来研究工作的模板。
更新日期:2020-05-16
中文翻译:
北美 COVID-19 ST 段抬高型心肌梗死 (NACMI) 登记处:基本原理、设计和影响。
导致 2019 年冠状病毒病 (COVID-19) 的新型冠状病毒,即严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2),已导致全球大流行。患有心血管危险因素或已确诊心血管疾病的患者更有可能患上严重或危重的 COVID-19 疾病,而心肌损伤是关键的肺外表现。由于多种病因,包括阻塞性、非阻塞性和/或血管造影正常的冠状动脉,这些患者经常在心电图 (ECG) 上出现 ST 段抬高。ST 段抬高型心肌梗死 (STEMI) 的发病率与 COVID-19 阳性住院患者相似,其与发病率和死亡率的关系尚不清楚。了解 ST 段抬高的 COVID-19 患者的自然史和适当的治疗对于为患者管理决策提供信息并保护医护人员至关重要。方法 心血管血管造影和介入协会 (SCAI) 和加拿大介入心脏病学协会 (CAIC) 与美国心脏病学会介入委员会合作创建了一个多中心观察登记处 NACMI。该登记系统将招募确诊的 COVID-19 患者和接受调查者 (PUI),这些患者和心电图上出现新发 ST 段抬高或新发左束支传导阻滞 (LBBB) 且临床怀疑心肌缺血的患者。我们将使用倾向匹配将这些患者的人口统计数据、临床发现、结果和管理与来自中西部 STEMI 联盟的超过 15,000 名连续 STEMI 激活患者的历史对照组进行比较。主要临床结果将是院内主要不良心血管事件(MACE),定义为由全因死亡率、卒中、复发性心肌梗死和确诊的 COVID-19 或 PUI 中的重复计划外血运重建组成的综合结果。次要结果将包括以下内容: ST 段抬高病因的报告;由于心肌梗塞、心脏骤停和/或休克导致的心血管死亡;主要结果的各个组成部分;1 年复合主要结局;以及心电图和血管造影特征。结论 多中心 NACMI 登记处将收集有关 COVID-19 患者心电图 ST 段抬高的数据,以确定病因和相关临床结果。该注册表创建、完善和推广的协作和速度可以作为未来研究工作的模板。