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Patients with COVID-19 with ST-elevated myocardial infarction constitute a high-risk single population with an increased threat of death and stroke in the hospital, based on the early effects of the North American Miocardial Infarction Registry with COVID-19 ST-Segment Elevation (NACMI).
Although patients with COVID-19 were less likely to undergo an angiography (PUI) for COVID-19 or older STEMI activation controls, 71% underwent percutaneous coronary intervention number one (PKI).
“Primary PKI is preferable and feasible in patients who are positive for COVID-19, with door-to-door times similar to those of negative PUI or COVID patients, and who support updated COVID-specific STEMI guidelines,” examines Co-Chair Timothy D. HenryArray MD said a last-minute clinical science consultation at TCT Connect, the virtual assembly of Transcatheter Cardiovascular Therapeutics (TCT) 2020.
The rules of multiple COVID-specific companies were originally published in April, approving the PKI as a popular treatment and allowing fibrillation-based remedy in hospitals that are not compatible with PKI.
Five previous publications from a total of 174 patients with COVID-19 with ST elevation showed that there were more common IAMCEST presentations in the hospital, plus cases without transparent culpable injury, more thrombotic lesions and microtrombos, and superior mortality, ranging from 12%. 72%. However, there has been great controversy over what to do exactly when patients with COVID-19 with ST elevation succeed in the catheterization lab, he said.
NACMI represents the greatest fun with PATIENTS with ST elevation and is an exclusive collaboration between the Society of Angiography and Cardiovascular Interventions (SCAI), the Canadian Association of Interventional Cardiology (CAIC), the American College of Cardiology and the STEMI Consortium of the Midwest, said Henry, medical director of the Lindner Center for Research and Education at The Christ Hospital Cincinnati Ohio.
The record recorded in the electrocardiogram any patient positive to COVID-19 or any user research over the age of 18 with ST segment elevation or a new left branch blockage with clinical correlation of myocardial ischemia such as chest pain, dyspnoea, heart failure. stop, shock or mechanical ventilation. There were no exclusion criteria.
Data from 171 patients with COVID-19 and 423 showed that PUIs from 64 sites were based on a population propensity of the Midwest STEMI Consortium, a prospective multicenter record of consecutive STEMI patients.
The 3 teams were similar in sex and age, but there was a notable difference in race, with 27% of African Americans and 24% of Hispanic patients through COVID compared to 11% and 6% in the PUI organization and 4% and 1% in the organization. Similarly, there has been a significant increase in diabetes (44% vs 33% vs 20%), which has been reported in the past with influenza.
Patients who tested positive for COVID-19, PUI and controls were particularly more likely to have cardiogenic surprise before PKI (20% vs 14% vs. 5%), but not cardiac arrest (12% vs 17% vs 11%), and have fractions of decreased left ventricle ejection (45% vs. 45% vs. 50%).
They also had more symptoms than IUP patients, namely chest X-ray infiltrators (49% vs. 17%) dyspnoea (58% vs. 38%). No data were available on these effects among the ancient witnesses.
Most importantly, 21% of patients with COVID-19 did not undergo angiography, 5% of IUP patients and 0% of controls (P
Surprisingly, there was no difference in ball times between COVID-positives, PUI and teams despite the existing pandemic (80 min vs 78 min vs 86 min).
But there was a marked increase in hospital mortality among patients who were positive for COVID-19 (32% vs. 12% and 6%; P
After the official presentation, guest host Philippe Gabriel Steg, MD, Imperial College London, UNITED Kingdom, said investigators had provided a fair service by reporting knowledge so quickly, but noted that an ongoing French record of times before and after The COVID-19 wave was not delighted with an increase in mortality rate.
“Can you explain whether the increase in mortality rate is similar to cardiovascular deaths or pneumonia, shocks, [acute respiratory misery syndromes] ARDS similar to COVID, etc. ?Because our impression, and this is what we publish in Lancet Public Health, is that cardiovascular morale does seem to be affected by COVID. “
Henry replied that these are early data, but “I’ll tell you that patients who had pKI had a mortality rate of only about 12% or 13% and patients who didn’t have angiography or who were treated with medical remedies had now, of course, it’s decided and we have to make a much bigger adjustment and look at that, but that’s our purpose and we’re going to have that information. ” Said.
At a press conference on the study, commentator Renu Virmani, MD, president and founder of the CVPath Institute, noted that in his investigation of 40 post-mortem cases in Bergamot, Italy, small intramyocardial microtrombos were observed in nine patients, while they were epicardial. microtrombos were noticed in 3 or four.
“Some of the cases are thought to be similar to coronary heart disease, but they would possibly be more thrombotic than anything else,” he said. “I think there’s a mix and that’s why the effects are so poor. show us the TIMI but it is something to consider: was TIMI another in deceased patients because you have very high mortality?I think we want to get to the back of the underlying cause of this thrombosis. “
Marco Valgimigli, MD, PhD, University Hospital bern, Switzerland, asked in the official presentation why 21% of STEMI patients had not undergone angiography and whether researchers can simply verify that STEMI patients, for whom they were not found guilty, had a buildup of cardiac troponin and were genuine myocardial infarctions or only had an ECG replacement that led to a number one PIC.
“All patients have had an ELEVATION of ST and all patients have a superior troponin, so the answer is, I think so,” Henry said. For others who pass the angiography, more complete data will still be provided “anecdotally, it seems that some of those patients were too much to pass and that some of those patients were already intubated or in ECMO in [extracorporeal oxygenation]. “
Henry noted that further analysis will be carried out, but that the record for this investigation has just ended last Sunday. During his presentation, he also made an argument for other sites to enroll in NACMI, and stated that in particular they were going to sites with the best prevalence of COVID and would likely load sites in Mexico and South America.
Future topics of interest come with ethnic and regional / national differences; The treatment time, adding the appearance of chest pain until arrival; transferred, hospitalized and do not blame the patients; adjustments over time the pandemic; and despite all the effects for a year, said Henry.
Press convention moderator Ajay Kirtane, MD, Director of Cardiac Catheterization Laboratories at NewYork-Presbyterian/Columbia University Irving, New York, commented that “often, other people will emphasize knowledge of observation, but this is precisely the kind of knowledge. That we want to check it out to collect data on what our practices are, how they are compatible. And I think many of us around the world will see this knowledge and echo their own experience. “
The study was funded by the Society of Angiogram and Cardiovascular Interventions and the Canadian Association of Interventional Cardiology. Henry did not disclose any applicable monetary relationships.
Transcatéter Cardiovascular Therapeutics (TCT) Connect. Presented on October 14, 2020.
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