STEMI in Hospitalized COVID-19 Patients at Higher Long-Term Mortality Risk: Study
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Canada: Researchers have found in a new study that hospitalized patients experiencing both ST-elevation myocardial infarction (STEMI) and COVID-19 showed a significantly increased risk of death, which persisted even after discharge, highlighting the lasting adverse impact of the dual condition.
A new analysis from the North American COVID-19 Myocardial Infarction (NACMI) Registry provides important insights into long-term outcomes among patients presenting with STEMI during the COVID-19 pandemic. The study, published in the Journal of the Society for Cardiovascular Angiography & Interventions and led by Payam Dehghani from Prairie Vascular Research Inc, Canada, evaluated one-year mortality trends in this high-risk population.
For this purpose, the researchers conducted a sub-study involving NACMI centers that collected extended follow-up data. A total of 2,358 patients with STEMI were included and categorized into three groups: those who tested positive for COVID-19 (623 patients), those who were COVID-19-negative (694 patients), and a historical control cohort of 1,041 patients treated before the pandemic (2018–2019). The primary endpoint assessed was all-cause mortality at one year.
Key Findings:
- A clear gradient in one-year mortality risk was observed across groups, with the highest rate in COVID-19-positive STEMI patients (45%), followed by COVID-19-negative patients (27%), and the lowest in historical controls (11%).
- The findings highlight the added mortality burden associated with COVID-19 in patients presenting with acute cardiac events.
- Most deaths (approximately 86%) occurred during the index hospitalization, particularly among patients with COVID-19.
- Despite surviving the initial hospital stay, patients continued to face an elevated risk of death over the following year.
- Among hospital survivors, one-year mortality remained higher in the COVID-19-positive group (12%) and COVID-19-negative group (9.6%) compared to the pre-pandemic control group (5.3%).
- These observations indicate that the adverse effects of COVID-19 in STEMI patients persist beyond the acute phase and extend into long-term outcomes.
The authors suggest that multiple factors may contribute to this persistent risk. Delays in seeking care during the pandemic, prolonged time to reperfusion therapy, and the complex biological effects of COVID-19—such as inflammation and thrombosis—may all play a role in worsening outcomes. Additionally, healthcare system disruptions during the pandemic may have influenced both acute management and follow-up care.
The study has some limitations. Use of all-cause mortality prevents clear attribution to cardiac causes, while missing data and incomplete follow-up may influence results. Comparisons with historical controls could also be affected by differences in healthcare delivery. Nevertheless, the strength and consistency of the findings support a clear link between COVID-19 status and higher mortality risk.
Overall, the study highlights that patients with STEMI during the COVID-19 era, particularly those infected with the virus, face a sustained and significantly higher risk of death. The findings emphasize the need for vigilant monitoring, timely intervention, and structured long-term follow-up in this vulnerable population.
Reference:
Dehghani, P., Ellingson BKin, C. J., Singh, J., Cravero, E., Mancini, G., Stanberry, L., Madan, M., Benziger, C. P., Ghasemzadeh, N., Bortnick, A. E., Kankaria, R., Grines, C. L., Nayak, K., Mahmud, E., Bainey, K. R., Alraies, M., Bagai, A., Patel, R. A., Amlani, S., . . . Henry, T. D. (2026). Persistent One-Year Mortality Gradient After STEMI and COVID-19: Long-Term Outcomes from the NACMI Registry. Journal of the Society for Cardiovascular Angiography & Interventions, 105395. https://doi.org/10.1016/j.jscai.2026.105395
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