North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality

• Published in: Journal of the Society for Cardiovascular Angiography & Interventions 2022-09, Vol.1 (5), p.100404-100404, Article 100404
• Main Authors: Dehghani, Payam, Schmidt, Christian W., Garcia, Santiago, Okeson, Brynn, Grines, Cindy L., Singh, Avneet, Patel, Rajan A.G., Wiley, Jose, Htun, Wah Wah, Nayak, Keshav R., Alraies, M. Chadi, Ghasemzadeh, Nima, Davidson, Laura J., Acharya, Deepak, Stone, Jay, Alyousef, Tareq, Case, Brian C., Dai, Xuming, Hafiz, Abdul Moiz, Madan, Mina, Jaffer, Faoruc A., Shavadia, Jay S., Garberich, Ross, Bagai, Akshay, Singh, Jyotpal, Aronow, Herbert D., Mercado, Nestor, Henry, Timothy D.
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2772-9303; 2772-9303
• DOI: 10.1016/j.jscai.2022.100404

BackgroundIn-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI. MethodsBaseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient. ResultsIn-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation 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 score (Cochran-Armitage χ2, P ​< ​.001), and the model demonstrated good discriminative power (c-statistic ​= ​0.81) and calibration (Hosmer-Lemeshow, P ​= ​.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high-risk score categories, respectively). ConclusionsThe risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.