Persistent One-Year Mortality Gradient After STEMI and COVID-19: Long-Term Outcomes From the NACMI Registry, 2026, Dehghani et al.

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Persistent One-Year Mortality Gradient After STEMI and COVID-19: Long-Term Outcomes From the NACMI Registry

Spoiler: Authors

Dehghani, Payam; Ellingson, Chase J.; Singh, Jyotpal; Cravero, Ellen; Mancini, G.B. John; Stanberry, Larissa; Madan, Mina; Benziger, Catherine P.; Ghasemzadeh, Nima; Bortnick, Anna E.; Kankaria, Rohan; Grines, Cindy L.; Nayak, Keshav; Mahmud, Ehtisham; Bainey, Kevin R.; Alraies, M. Chadi; Bagai, Akshay; Patel, Rajan A.G.; Amlani, Shy; Case, Brian C.; Waksman, Ron; Shavadia, Jay S.; Stone, Jay H.; Acharya, Deepak; Javed, Nosheen; Bagur, Rodrigo; Garberich, Ross; Garcia, Santiago; Henry, Timothy D.

Abstract​

Background​

Patients with COVID-19 and ST-elevation myocardial infarction (STEMI) from the North American COVID-19 Myocardial Infarction (NACMI) registry had elevated in-hospital mortality compared with COVID-19-negative patients and historical controls. We examined 1-year mortality outcomes from the NACMI registry.

Methods​

This was a substudy of NACMI centers that participated in long-term follow-up.
Patients in the NACMI registry were stratified into COVID-19-positive and COVID-19-negative groups.
A historical 2018-2019 control group was derived from the Midwest STEMI Consortium registry.
The primary outcome was 1-year mortality.

Results​

A total of 2358 STEMI patients (30% female) were included in this study, divided into 3 subgroups: COVID-19-positive (n = 623), COVID-19-negative (n = 694), and historical controls (n = 1041).
One-year mortality in COVID-19-positive patients was 45% (HR, 4.88; 95% CI, 3.73-6.39; P < .001), compared with 27% (HR, 3.93; 95% CI, 2.92-5.29; P < .001) in COVID-19-negative patients and 11% in matched controls (P< .001).
Most deaths (86%) occurred during the index hospitalization, with a median time to death of 27 days (IQR 6, 343) in the COVID-19-positive group.
Among survivors of index hospitalization, 1-year mortality was 12% (COVID-19-positive; HR, 2.20; 95% CI, 1.26-3.85; P = .006), 9.6% (COVID-19-negative; HR, 2.31; 95% CI, 1.26-4.21; P = .007), and 5.3% (controls) (P< .001).

Conclusions​

This study describes long-term outcomes in patients with STEMI and COVID-19.
We demonstrate that the excess mortality risk associated with COVID-19 STEMI extends beyond the index hospitalization and exhibits a clear risk gradient.
The cause is likely multifactorial, including pandemic-era disruptions in care, longer time-to-treatment, and the unique pathophysiology of COVID-19 STEMI.


Web | DOI | PMC | PDF | Journal of the Society for Cardiovascular Angiography & Interventions | Open Access

 

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See also

Association of long-COVID with major adverse cardiovascular events and mortality: a real-world data cohort study

Spoiler: Authors

Tsai, Yueh-Ting; Wang, Bo-Yuan; Ho, Sai-Wai; Yang, Shun-Fa; Wang, Yu-Hsun; Yeh, Chao-Bin; Chen, Ying-Cheng

BACKGROUND
There is a limited body of research examining the association between long COVID and major adverse cardiovascular events (MACE) as well as all-cause mortality. This study aimed to investigate the association between long COVID and both MACE and mortality.

METHODS
This retrospective cohort study utilized multicenter real-world data from the TriNetX research network platform, which contains electronic health records from multiple healthcare organizations. Patients aged 18 years and older who were diagnosed with COVID-19 between 2020 and 2023 were included. The exposure group comprised individuals diagnosed with long-COVID within 3 to 6 months after their initial COVID-19 diagnosis, while the comparison group included COVID-19 patients without a diagnosis of long-COVID. The primary outcomes were the risk of major adverse cardiovascular events (MACE) and all-cause mortality. Follow-up commenced 90 days after the index date and continued until the occurrence of the study outcome or the date of the last available medical record.

RESULTS
The risk of MACE was markedly higher in the long-COVID cohort compared to the non-long-COVID cohort. The overall hazard ratio (HR) for MACE was 4.48 (95% CI: 3.95–5.07). Specific conditions such as coronary artery disease and stroke exhibited particularly high HRs, at 6.48 (5.29–7.95) and 3.46 (2.96–4.04) respectively. Mortality was significantly higher in the long-COVID group, with an HR of 1.53 (1.38–1.69).

CONCLUSIONS
Compared to patients without long COVID, patients with long COVID had a higher risk of developing MACE.

Web | DOI | PDF | BMC Cardiovascular Disorders | Open Access