The Midwest ST-Elevation Myocardial Infarction Consortium: Design and Rationale

Yıldız, Mehmet; Sharkey, Scott W.; Aguirre, Frank V.; Tannenbaum, Mark; Garberich, Ross; Smith, Timothy D.; Shivapour, Daniel; Schmidt, Christian; Pacheco-Coronado, Roberto; Rohm, Heather; Chambers, Jenny; Coulson, Teresa; García, Santiago; Henry, Timothy D.

doi:10.1016/j.carrev.2020.08.019

Cited by 12 publications

(14 citation statements)

References 31 publications

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“…The Midwest STEMI Consortium is a collaboration of 4 large regional STEMI programs: Iowa Heart Center in Des Moines, Iowa; Minneapolis Heart Institute Foundation in Minneapolis, Minnesota; Prairie Cardiovascular in Springfield, Illinois; and The Christ Hospital in Cincinnati, Ohio. Each has similar standardized STEMI protocols and together include >100 referral hospitals and several emergency medical services ( 14 ). A comprehensive database includes traditional risk factors, detailed angiographic characteristics, time-to-reperfusion data, and short- and long-term clinical outcomes up to 5 years for MI, stroke, severe bleeding, and all-cause mortality and up to 10 years for mortality.…”

Section: Methodsmentioning

confidence: 99%

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

García¹,

Dehghani²,

Grines³

et al. 2021

Journal of the American College of Cardiology

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111

157

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Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). Conclusions COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.

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Section: Methodsmentioning

confidence: 99%

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

García¹,

Dehghani²,

Grines³

et al. 2021

Journal of the American College of Cardiology

Self Cite

111

157

View full text Add to dashboard Cite

show abstract

“…The Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, Minnesota and The Christ Hospital in Cincinnati, Ohio are two tertiary, regional, referral centers with well‐established STEMI systems of care—Level 1 myocardial infarction (MI) and STEMI alert, respectively. These two referral centers follow similar standardized STEMI protocols and are part of the Midwest STEMI Consortium 19 …”

Section: Methodsmentioning

confidence: 99%

“…These two referral centers follow similar standardized STEMI protocols and are part of the Midwest STEMI Consortium. 19 All STEMI activations up to 24 h of symptom onset based on ST-segment elevation or new left bundle branch block with ischemic symptoms were prospectively included in each center.…”

Section: Study Populationmentioning

confidence: 99%

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Griffin

Yıldız

Bradley

et al. 2022

Cathet Cardio Intervent

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Objectives To assess the characteristics and prognosis of ST‐elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. Background Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late‐presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. Methods Using a two‐center registry‐based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3−6, 6−12, and 12−24 h (late presenters). Results Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid‐19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door‐to‐balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In‐hospital and 1‐year death risks were comparable between late and earlier presenters. Conclusion Despite the unfavorable risk profile and longer door‐to‐balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

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“…Overall, the critical components of optimized regional STEMI systems of care are well-established standardized STEMI protocols, which should include: (1) predetermined STEMI diagnosis criteria; (2) activation of the system with a single phone call; (3) pre-identified transport plans to PCI centers; and (4) administration of the guideline-recommended antithrombotic therapies. Additionally, regional STEMI systems of care have provided essential insights into STEMI care through the use of detailed prospective registries, which have the advantages of: (1) including all STEMI patients without exclusion criteria; (2) providing a detailed database for high-risk STEMI patients such as CS or OHCA; (3) presenting detailed angiographic features; and (4) compiling robust long-term follow-up data [1] , [4] , [21] .…”

Section: Regional Stemi Systems Of Carementioning

confidence: 99%

STEMI care 2021: Addressing the knowledge gaps

Yıldız

Wade

Henry

2021

American Heart Journal Plus: Cardiology Research and Practice

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Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care.

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The Midwest ST-Elevation Myocardial Infarction Consortium: Design and Rationale

Cited by 12 publications

References 31 publications

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

Initial Findings From the North American COVID-19 Myocardial Infarction Registry

Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

STEMI care 2021: Addressing the knowledge gaps

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