COVID-19 Amplifies 1-Year STEMI Mortality Following Hospitalization

A new sub-study of the North American COVID-19 Myocardial Infarction (NACMI) Registry has shown that patients with COVID-19 and ST-elevation myocardial infarction (STEMI) continued to display higher mortality than pre-pandemic after hospital discharge.1

These data were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions in Montreal, Canada, by Payam Dehghani, MD, associate professor of cardiology at the University of Saskatchewan and co-founder of Prairie Vascular Research, Inc. Following the conclusion of the conference, the editorial team at HCPLive spoke with Dehghani in an exclusive interview to learn more about the data.

“We know that if you have a heart attack and you have COVID-19, you’re much more likely to die in hospital,” Dehghani told HCPLive. “We published on that back in 2020 and 2021, that is not a surprise to anyone. What we don’t know is, if you survive hospitalization, for the remainder of your time outside the hospital, does your mortality look any different compared to people who have not had COVID-19?”

Registry Structure

The NACMI Registry was designed as a prospective, investigator-initiated, multi-center observational registry enrolling confirmed COVID-19 patients and persons under investigation (PUIs) with new ST-segment elevation or new onset left bundle branch block (LBBB) on the electrocardiogram with clinical suspicion of myocardial ischemia. These patients were enrolled from April 2020 to June 2021. Demographic information, descriptors at presentation with STEMI, and clinical outcomes were captured by the registry.2

Patients aged ≥18 years with ST-segment elevation in ≥2 contiguous leads, a clinical correlate of myocardial ischemia, and confirmed COVID-19 infection, were eligible for enrollment. Those without available vital status were excluded, as were those with a “do not resuscitate” status or multiple futility markers on admission. The study’s primary outcome was in-hospital all-cause mortality.2

Outcomes

A total of 474 patients with COVID-19 and STEMI were enrolled in the registry – 49 were excluded due to incomplete data or comfort care measures, leaving 425 patients for the study. The majority of patients were men (72%) aged 56-75 years and were more likely to be of minority ethnicity (21% Hispanic, 18% Black, 7% Asian) than White (46%).2

Among these patients, 118 (28%) died in the hospital. Of the variables present at the time of diagnosis, including respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation <93%, age of >55 years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea, were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk scores.1

NACMI Sub-Study Data

The current sub-study included a total of 623 patients who were COVID-19 positive, along with 694 who were COVID-19 negative and a matched control cohort of 1041 patients collected from data recorded before COVID-19. Among the COVID-19 positive patients, 1-year mortality was 45% compared to 27% in the COVID-19 negative arm and 11% in the matched control arm (P <.001). Most deaths occurred during index hospitalization (86%), with a median time to death of 27 days (interquartile range [IQR] 6, 343). Of the patients who survived index hospitalization, 1-year mortality rates were 12% in the COVID-19 positive arm, 9.6% in the COVID-19 negative arm, and 5.3% in the matched control arm (P <.001).1

Ultimately, Dehghani and colleagues noted that the high mortality among patients with COVID-19 and STEMI was driven predominately by deaths during the index hospitalization. Of those who survived to hospital discharge, mortality rates remained higher than pre-pandemic controls. The team determined that this difference reflects a need for intervention beyond the acute phase.1

“Time is muscle. We’ve known this all along, but we forget about it, both for patient education programs and maybe even at hospitals,” Dehghani said. “Heart attack rates don’t drop – in fact, they probably go up during influenza and pandemics. I think we need to amplify that message, and I think our systems of care need to be made aware of that.”

Editors’ Note: Dehghani reports no relevant disclosures.

References

1. Dehghani P. North American COVID-19 Myocardial Infarction (NACMI) Registry: One-Year Follow-Up. Presented at the SCAI 2026 Scientific Sessions, Montreal, Canada. April 23-25, 2026.

2. Dehghani P, Schmidt CW, Garcia S, Okeson B, Grines CL, Singh A, Patel RAG, Wiley J, Htun WW, Nayak KR, Alraies MC, Ghasemzadeh N, Davidson LJ, Acharya D, Stone J, Alyousef T, Case BC, Dai X, Hafiz AM, Madan M, Jaffer FA, Shavadia JS, Garberich R, Bagai A, Singh J, Aronow HD, Mercado N, Henry TD. North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality. J Soc Cardiovasc Angiogr Interv. 2022 Sep-Oct;1(5):100404. doi:10.1016/j.jscai.2022.100404.