North American COVID-19 ST-Elevation Myocardial Infarction (STEMI) Research Reveals Impact on Minority Populations, High Mortality and Atypical Symptoms

First Data from North American COVID-19 Myocardial Infarction Registry Published in Journal of the American College of Cardiology
Apr 19, 2021

MINNEAPOLIS  The Minneapolis Heart Institute Foundation® (MHIF) announced today the first publication of outcomes from the North American COVID-19 ST-Segment Elevation Myocardial Infarction (STEMI) Registry (NACMI) showing that COVID-positive patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics that are important to consider in providing optimal care.

Important findings include:

  • Minorities were disproportionally affected: nearly 50 percent of the STEMI patients had minority ethnicity (23 percent Hispanic; 24 percent Black)
  • In-hospital mortality was high: 33 percent (4% for controls without COVID)
  • Symptoms were unique: majority (54 percent) presented with respiratory symptoms (shortness of breath) rather than chest pain
  • Significant proportion of COVID-positive patients presented with high-risk STEMI: cardiogenic shock (18 percent) and cardiac arrest (11 percent), which may explain the high fatality rate
  • Primary angioplasty remained the dominant revascularization modality during the pandemic with small treatment delays (@ 15 minutes).

At the start of the COVID-19 pandemic, the management of STEMI patients with confirmed or suspected COVID infection was controversial as some were advocating for pharmacological reperfusion (thrombolytic therapy) to protect essential health care works and resources. That strategy is associated with delays in reperfusion, increased mortality and risk of heart failure.

“This research has provided critical insights into the care of STEMI patients during the COVID-19 pandemic and has revealed the importance of understanding demographic and clinical factors that are unique and different from what has historically been seen in patients prior to the pandemic,” said Santiago Garcia, MD, interventional cardiologist, researcher and primary investigator for MHIF, which is the international coordinating center for the study. “This extensive research registry is an effort from 64 sites across North America that have worked to compile data, share insights and inform outcomes in patients as we treat heart attacks that continue to happen during this pandemic. We’ve learned that the signs and symptoms are different while the importance of prompt treatment with primary percutaneous coronary intervention (PPCI) remains a standard of care that is critical to maintain good outcomes for STEMI patients, including minority populations who may not present initially with common symptoms.”

Among COVID-positive patients who received angiography, 71 percent received PPCI and 20 percent received medical therapy. The primary endpoint was a composite of in-hospital death, stroke, recurrent myocardial infarction (MI) or unplanned revascularization and occurred in 36 percent of COVID-positive patients, 13 percent of persons under investigation for COVID-19 (PUIs) and 4 percent of control patients. The registry underscores that PPCI (the current recommendation for STEMI) is feasible, but the reality is the combination of STEMI and COVID-19 carries a poor prognosis, with 1 in 3 patients succumbing to the disease, even among those treated with state-of-the-art invasive angiography (28 percent mortality).

NACMI is the largest STEMI registry in patients with confirmed or suspected COVID-19 infection. The present analysis included patients from 64 clinical sites from across the U.S. and Canada. A total of 1,185 patients were included in this first report : 230 COVID-positive STEMI patients, 495 STEMI patients suspected but ultimately confirmed not to have COVID-19, and 460 age- and sex-matched control STEMI patients treated prior to the pandemic. The comparative group was pulled from the existing Midwest STEMI Consortium, which is a large (>15,000), prospective multi-center registry of consecutive STEMI patients for which MHIF is the data coordinating center.

The NACMI registry is a collaborative effort between the Society for Cardiovascular Angiography and Interventions (SCAI) and the Canadian Association of Interventional Cardiology (CAIC). It is a research study designed to collect data on COVID-19 positive patients or persons under investigation (suspected to have COVID-19 infection) with ST-Elevation Myocardial Infarction (STEMI), a serious heart attack involving a blockage in one of the heart’s major arteries.


About Minneapolis Heart Institute Foundation®

The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.

Scientific Innovation and Research – MHIF is a recognized leader across all specialties of heart and vascular research. Each year, MHIF leads more than 200 research studies with more than 2,200 patients and publishes more than 200 articles to share learnings from research. MHIF research has improved the standard of care around the world through protocols like Level One for heart attack, which significantly improved outcomes and survival for patients.

Education and Outreach – MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes among health care providers. This commitment extends to patients and caregivers through a number of community health and education events to raise awareness of heart care and research, engaging individuals in their own health.

The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and engages in cutting-edge research initiatives with its physician partners from the Minneapolis Heart Institute® at Abbott Northwestern Hospital and at 38 community sites across Minnesota and western Wisconsin. For more information, please visit