Baseline ECG Outperforms the Angiogram for Predicting Mortality in COVID-19–Associated STEMI: Insights From the NACMI Registry

作者：Kevin R. Bainey, Payam Dehghani, Jyotpal Singh, G.B. John Mancini, Ross Garberich, Seth Bergstedt, Shaun G. Goodman, Wah Wah Htun, Catherine P. Benziger, Nima Ghasemzadeh, Anna E. Bortnick, Rohan Kankaria, Cindy L. Grines, Keshav R. Nayak, M. Chadi Alraies, Rajan A.G. Patel, Rosa M. Marticorena, Shy Amlani, Santiago García, Timothy D. Henry · 发表于：Journal of the Society for Cardiovascular Angiography & Interventions · 年份：2025 · DOI：10.1016/j.jscai.2025.103994 · 被引用次数：1 · 研究领域：Acute Myocardial Infarction Research、COVID-19 Clinical Research Studies、COVID-19 and healthcare impacts

Background Patients with COVID-19 continue to present with ST-elevation myocardial infarction (STEMI). To date, there have been no core laboratory electrocardiogram (ECG) description of these patients. Accordingly, we aimed to evaluate the ECG characteristics and coronary angiograms of patients hospitalized with COVID-19–associated STEMI. Methods In a prespecified analysis from the North American COVID-19 Myocardial Infarction (NACMI) registry, we collected baseline STEMI ECGs in COVID-19–positive patients for core laboratory interpretation (Canadian VIGOUR Centre, Edmonton, Canada), including ST-segment analysis, worst lead ST-elevation (ST-E), sum ST-elevation (ΣST-E), and sum ST deviation (ΣST-D). Available core laboratory angiograms (Cardiovascular Imaging Research Core Laboratory, Vancouver, Canada) were also collected. ECG and angiographic variables associated with in-hospital death were analyzed. Results Of the 392 patients, 28.1% died in-hospital. Greater median ST-E (deviation) was observed in those who died (ST-E: 2.20 vs 1.65 mm; P = .006; ΣST-E: 7 vs 5 mm; P = .005; ΣST-D: 11 vs 9 mm; P = .013, respectively). Following adjustment for clinical characteristics, ΣST-D was a positive predictor of in-hospital death (relative risk [RR], 1.03; 95% CI, 1.01-1.05; P = .003). In 173 patients with available coronary angiograms, 32% of the baseline ECGs could not define infarct location (19% with angiography). Following adjustment, only ECG characteristics were independent pr...