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      Initial Findings From the North American COVID-19 Myocardial Infarction Registry

      research-article
      , MD a , , , MD b , , MD c , d , , MD e , , MD f , , MD g , , MD h , , MD i , , MD j , , MS, MBA a , , MS a , , MD, SM k , , MD a , , MD l , , MD m , , MD n , , MD o , , MD p , , MD q , , MD r , , MD s , , MD t , , MD u , , MD v , , MD w , , MD x , , MD y , , MD z , , MD aa , , MD, PhD bb , cc , , MD dd , , MD dd , , MD ee , , MD ff , , MD gg , , MD hh , , MD ii , , MD, MSc jj , , MD jj , , MD, PhD jj , , MD kk , , MD ll , , MD h , , MD mm , , MD nn , , MD oo , , MD pp , , MD qq , , MD rr , , MD ss , , MD tt , , MD uu , , MD vv , , MD ww , , MD xx , , MD yy , , MD zz , , MD aaa , bbb , , MD, MPH pp , , MD ccc , , MD ddd , Society for Cardiac Angiography and Interventions, the Canadian Association of Interventional Cardiology, and the American College of Cardiology Interventional Council
      Journal of the American College of Cardiology
      the American College of Cardiology Foundation. Published by Elsevier.
      COVID-19, outcomes, ST-segment myocardial infarction, ACC, American College of Cardiology, COVID-19, coronavirus disease 2019, D2B, door to balloon, IQR, interquartile range, MI, myocardial infarction, PPCI, primary percutaneous coronary intervention, PUI, person under investigation, SCAI, Society for Cardiac Angiography and Interventions, STEMI, ST-segment elevation myocardial infarction

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          Abstract

          Background

          The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI).

          Objectives

          The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI.

          Methods

          A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization.

          Results

          As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients).

          Conclusions

          COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Is Open Access

            OpenSAFELY: factors associated with COVID-19 death in 17 million patients

            COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.
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              Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)

              Question What are the cardiovascular effects in unselected patients with recent coronavirus disease 2019 (COVID-19)? Findings In this cohort study including 100 patients recently recovered from COVID-19 identified from a COVID-19 test center, cardiac magnetic resonance imaging revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), which was independent of preexisting conditions, severity and overall course of the acute illness, and the time from the original diagnosis. Meaning These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19. This cohort study evaluates the presence of myocardial injury in unselected patients recently recovered from coronavirus disease 2019 (COVID-19). Importance Coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. Case reports of hospitalized patients suggest that COVID-19 prominently affects the cardiovascular system, but the overall impact remains unknown. Objective To evaluate the presence of myocardial injury in unselected patients recently recovered from COVID-19 illness. Design, Setting, and Participants In this prospective observational cohort study, 100 patients recently recovered from COVID-19 illness were identified from the University Hospital Frankfurt COVID-19 Registry between April and June 2020. Exposure Recent recovery from severe acute respiratory syndrome coronavirus 2 infection, as determined by reverse transcription–polymerase chain reaction on swab test of the upper respiratory tract. Main Outcomes and Measures Demographic characteristics, cardiac blood markers, and cardiovascular magnetic resonance (CMR) imaging were obtained. Comparisons were made with age-matched and sex-matched control groups of healthy volunteers (n = 50) and risk factor–matched patients (n = 57). Results Of the 100 included patients, 53 (53%) were male, and the mean (SD) age was 49 (14) years. The median (IQR) time interval between COVID-19 diagnosis and CMR was 71 (64-92) days. Of the 100 patients recently recovered from COVID-19, 67 (67%) recovered at home, while 33 (33%) required hospitalization. At the time of CMR, high-sensitivity troponin T (hsTnT) was detectable (greater than 3 pg/mL) in 71 patients recently recovered from COVID-19 (71%) and significantly elevated (greater than 13.9 pg/mL) in 5 patients (5%). Compared with healthy controls and risk factor–matched controls, patients recently recovered from COVID-19 had lower left ventricular ejection fraction, higher left ventricle volumes, and raised native T1 and T2. A total of 78 patients recently recovered from COVID-19 (78%) had abnormal CMR findings, including raised myocardial native T1 (n = 73), raised myocardial native T2 (n = 60), myocardial late gadolinium enhancement (n = 32), or pericardial enhancement (n = 22). There was a small but significant difference between patients who recovered at home vs in the hospital for native T1 mapping (median [IQR], 1119 [1092-1150] ms vs 1141 [1121-1175] ms; P  = .008) and hsTnT (4.2 [3.0-5.9] pg/dL vs 6.3 [3.4-7.9] pg/dL; P  = .002) but not for native T2 mapping. None of these measures were correlated with time from COVID-19 diagnosis (native T1: r  = 0.07; P  = .47; native T2: r  = 0.14; P  = .15; hsTnT: r  = −0.07; P  = .50). High-sensitivity troponin T was significantly correlated with native T1 mapping ( r  = 0.33; P  < .001) and native T2 mapping ( r  = 0.18; P  = .01). Endomyocardial biopsy in patients with severe findings revealed active lymphocytic inflammation. Native T1 and T2 were the measures with the best discriminatory ability to detect COVID-19–related myocardial pathology. Conclusions and Relevance In this study of a cohort of German patients recently recovered from COVID-19 infection, CMR revealed cardiac involvement in 78 patients (78%) and ongoing myocardial inflammation in 60 patients (60%), independent of preexisting conditions, severity and overall course of the acute illness, and time from the original diagnosis. These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19.
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                Author and article information

                Journal
                J Am Coll Cardiol
                J Am Coll Cardiol
                Journal of the American College of Cardiology
                the American College of Cardiology Foundation. Published by Elsevier.
                0735-1097
                1558-3597
                19 April 2021
                27 April 2021
                19 April 2021
                : 77
                : 16
                : 1994-2003
                Affiliations
                [a ]Minneapolis Heart Institute Foundation. Minneapolis, Minnesota, USA
                [b ]Prairie Vascular Research, Regina, Saskatchewan, Canada
                [c ]Northside Cardiovascular Institute, Atlanta, Georgia, USA
                [d ]Society for Cardiovascular Angiography and Interventions, Washington, DC, USA
                [e ]Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
                [f ]Department of Cardiology, Scripps Mercy Hospital, San Diego, California, USA
                [g ]Vancouver General Hospital, Vancouver, British Columbia, Canada
                [h ]MedStar Washington Hospital Center, Washington, DC, USA
                [i ]University of Chicago, Chicago, Illinois, USA
                [j ]St. Michael’s Hospital, Toronto, Ontario, Canada
                [k ]University of Montreal, Montreal, Quebec, Canada
                [l ]University of New Mexico, Albuquerque, New Mexico, USA
                [m ]University of Miami, Miami, Florida, USA
                [n ]University of Kentucky, Lexington, Kentucky, USA
                [o ]University of Arizona Sarver Heart Center, Tucson, Arizona, USA
                [p ]Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
                [q ]Southern Illinois University School of Medicine, Springfield, Illinois, USA
                [r ]Southcoast Health System, New Bedford, Massachusetts, USA
                [s ]Royal University Hospital, Saskatchewan Health, Saskatoon, Saskatchewan, Canada
                [t ]Community Medical Center, RWJ Barnabas Health, Toms River, New Jersey, USA
                [u ]DMC Harper University Hospital, Detroit, Michigan, USA
                [v ]Gundersen Health System, La Crosse, Wisconsin, USA
                [w ]Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
                [x ]TIMI Study Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
                [y ]Cedars Sinai Heart Institute, Los Angeles, California, USA
                [z ]Cook County Health and Hospitals System, Chicago, Illinois, USA
                [aa ]Delray Medical Center, Tenet Healthcare, Delray Beach, Florida, USA
                [bb ]Frederick Health Hospital, Frederick, Maryland, USA
                [cc ]Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                [dd ]Holy Cross Hospital, Fort Lauderdale, Florida, USA
                [ee ]Horizon Health Network, Saint John, New Brunswick, Canada
                [ff ]Iowa Heart, West Des Moines, Iowa, USA
                [gg ]Frederick Health Hospital, Frederick, Maryland, USA, and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
                [hh ]London Health Sciences Centre, Western University, London, Ontario, Canada
                [ii ]Louisiana State University, New Orleans, Louisiana, USA
                [jj ]Massachusetts General Hospital, Boston, Massachusetts, USA
                [kk ]Mayo Clinic Jacksonville, Jacksonville, Florida, USA
                [ll ]Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
                [mm ]Mercy St. Vincent’s Medical Center, Toledo, Ohio, USA
                [nn ]NewYork-Presbyterian Queens, Flushing, New York, USA
                [oo ]Nova Scotia Health, Halifax, Nova Scotia, Canada
                [pp ]University of Pennsylvania, Philadelphia, Pennsylvania, USA
                [qq ]St. Mary’s General Hospital, Kitchener, Ontario, Canada
                [rr ]St. Vincent Hospital, Worcester, Massachusetts, USA
                [ss ]Prairie Heart Institute at HSHS St. John's Hospital, Springfield, Illinois, USA
                [tt ]UMass Memorial Medical Center, Worcester, Massachusetts, USA
                [uu ]University of Ottawa Heart Institute, Ottawa, Ontario, Canada
                [vv ]UT Southwestern Medical Center, Dallas, Texas, USA
                [ww ]William Osler Health System, Brampton, Ontario, Canada
                [xx ]Windsor Regional Hospital, Windsor, Ontario, Canada
                [yy ]Ochsner Medical Center, New Orleans, Louisiana, USA
                [zz ]Canadian Association of Interventional Cardiology, Ottawa, Ontario, Canada
                [aaa ]American College of Cardiology Interventional Cardiology Section Leadership Council, Washington, DC, USA
                [bbb ]University of Utah Health Sciences, Salt Lake City, Utah, USA
                [ccc ]Sulpizio Cardiovascular Center, University of California San Diego, La Jolla, California, USA
                [ddd ]Carl and Edyth Lindner Center for Research and Education, the Christ Hospital, Cincinnati, Ohio, USA
                Author notes
                [] Address for correspondence: Dr. Santiago Garcia, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 300, Minneapolis, Minnesota 55407, USA.
                Article
                S0735-1097(21)00565-9
                10.1016/j.jacc.2021.02.055
                8054772
                33888249
                11578175-7729-4703-b9d8-270551a6ed2e
                © 2021 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 8 February 2021
                : 22 February 2021
                Categories
                Original Investigation

                Cardiovascular Medicine
                covid-19,outcomes,st-segment myocardial infarction,acc, american college of cardiology,covid-19, coronavirus disease 2019,d2b, door to balloon,iqr, interquartile range,mi, myocardial infarction,ppci, primary percutaneous coronary intervention,pui, person under investigation,scai, society for cardiac angiography and interventions,stemi, st-segment elevation myocardial infarction

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