Trends in Clinical Presentation, Management, and Outcomes of STEMI in Patients With COVID-19

Santiago Garcia*, Payam Dehghani, Larissa Stanberry, Cindy Grines, Rajan A.G. Patel, Keshav R. Nayak, Avneet Singh, Wah Wah Htun, Ameer Kabour, Nima Ghasemzadeh, Cristina Sanina, Joseph Aragon, M. Chadi Alraies, Catherine Benziger, Brynn Okeson, Ross Garberich, Frederick G. Welt, Laura Davidson, Abdul Moiz Hafiz, Deepak AcharyaJay Stone, Aditya Mehra, Shy Amlani, Ehtisham Mahmud, Jay Giri, Mehmet Yildiz, Timothy D. Henry

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Background: We previously reported high in-hospital mortality for ST-segment elevation myocardial infarction (STEMI) patients with COVID-19 treated in the early phase of the pandemic. Objectives: The purpose of this study was to describe trends of COVID-19 patients with STEMI during the course of the pandemic. Methods: The NACMI (North American COVID-19 STEMI) registry is a prospective, investigator-initiated, multicenter, observational registry of hospitalized STEMI patients with confirmed or suspected COVID-19 infection in North America. We compared trends in clinical characteristics, management, and outcomes of patients treated in the first year of the pandemic (January 2020 to December 2020) vs those treated in the second year (January 2021 to December 2021). Results: A total of 586 COVID-19–positive patients with STEMI were included in the present analysis; 227 treated in Y2020 and 359 treated in Y2021. Patients’ characteristics changed over time. Relative to Y2020, the proportion of Caucasian patients was higher (58% vs 39%; P < 0.001), patients presented more frequently with typical ischemic symptoms (59% vs 51%; P = 0.04), and patients were less likely to have shock pre-PCI (13% vs 18%; P = 0.07) or pulmonary manifestations (33% vs. 47%; P = 0.001) in Y2021. In-hospital mortality decreased from 33% (Y2020) to 23% (Y2021) (P = 0.008). In Y2021, none of the 22 vaccinated patients expired in hospital, whereas in-hospital death was recorded in 37 (22%) unvaccinated patients (P = 0.009). Conclusions: Significant changes have occurred in the clinical characteristics and outcomes of STEMI patients with COVID-19 infection during the course of the pandemic.

Original languageEnglish (US)
Pages (from-to)2236-2244
Number of pages9
JournalJournal of the American College of Cardiology
Issue number22
StatePublished - Jun 7 2022


  • COVID-19
  • heart attack
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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