Abstract :
Background 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. Author Affiliation: (a) Prairie Vascular Research Inc, Regina, Saskatchewan, Canada (b) Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada (c) Northwestern University, Feinberg School of Medicine, Chicago, IL (d) American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC (e) Society for Cardiovascular Angiography and Interventions, Washington, DC (f) Northside Cardiovascular Institute, Atlanta, GA (g) Deparment of Cardiology Scripps Mercy Hospital, San Diego, CA (h) Vancouver General Hospital, Vancouver, British Columbia, Canada (i) Piedmont Heart Institute, Atlanta, GA (j) St. Michael's Hospital, Toronto, Ontario, Canada (k) Minneapolis Heart Institute, Minneapolis, MN (l) Department of Medicine, Montreal Heart Institute, Université de Montréal (m) Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, PA (n) Hofstra North Shore -- LIJ School of Medicine, Manhasset, NY (o) Department of Medicine (Cardiology), VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY (p) Centre for Cardiovascular Innovation, UBC Division of Cardiology, St Paul's and Vancouver General Hospital, Vancouver, Canada (q) Cardiovascular Division, University of Utah Health, Salt Lake City, UT (r) University of California, San Diego, Sulpizio Cardiovascular Center, La Jolla, CA (s) The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH * Reprint requests: Timothy D. Henry, MD, The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, 2123 Auburn Avenue, Suite 424, Cincinnati, OH 45219. Article History: Received 27 April 2020; Accepted 7 May 2020 (footnote) Funding: None. Byline: Payam Dehghani, MD (a,b), Laura J. Davidson, MD (c,d,e), Cindy L. Grines, MD (e,f), Keshav Nayak, MD (e,g), Jacqueline Saw, MD (b,h), Prashant Kaul, MD (d,e,i), Akshay Bagai, MD (b,j), Ross Garberich, MS (k), Christian Schmidt, MS (k), Hung Q. Ly, MD, SM (b,l), Jay Giri, MD (m), Perwaiz Meraj, MD (e,n), Binita Shah, MD (o), Santiago Garcia, MD (e,k), Scott Sharkey, MD (k), David A. Wood, MD (b,p), Frederick G. Welt, MD (d,e,q), Ehtisham Mahmud, MD (e,r), Timothy D. Henry, MD [Tim.henry@thechristhospital.com] (d,e,s,*)