Advertisement
Canadian Journal of Cardiology

A COMPARATIVE ANALYSIS OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION BETWEEN CANADA AND THE UNITED STATES FROM THE NORTH AMERICAN COVID-19 STEMI REGISTRY

      Background

      Important healthcare differences exist between the US and Canada. The goal of this investigation is to compare clinical characteristics, treatment strategies and clinical outcomes of STEMI patients with COVID-19 infection treated in the US versus Canada.

      Methods and Results

      The North American COVID-19 Myocardial Infarction (NACMI) registry is a prospective, investigator-initiated study enrolling STEMI patients with documented COVID infection in the US and Canada. The primary end-point is in-hospital mortality. The secondary end-points include stroke, reinfarction and a composite of death, stroke or reinfarction. Of the 767 STEMI-COVID patients, 67 (9%) were from Canada and 669 (91%) from the US. Patients enrolled in Canada were more likely to present with chest pain (79% vs. 54%, p< 0.001), otherwise patients across both countries had comparable presenting demographics (Table 1). The proportion of patients not undergoing coronary angiography was significantly lower in Canada compared with the US (9% vs. 19%, p=0.039); of those who underwent angiography, no significant differences in reperfusion modalities were noted. Compared with the US, patients in Canada had a significantly lower unadjusted risk for in-hospital mortality (15% vs. 29%, p=0.016) and the risk for the composite of death, stroke or re-infarction (15% vs. 31%, p=0.006). Vaccination status was available in Canada 26 / 67 patients (unvaccinated 13, vaccinated 13) and US 328/ 669 patients (unvaccinated 282, vaccinated 46); a strong association between vaccination and adverse clinical composite is noted in both countries (Canada: 3/13, 23% (unvaccinated) vs. 0/13, 0% (vaccinated), p=0.22; and, US: 75/282, 27% (unvaccinated) vs. 6/46, 13% (vaccinated), p=0.048).