Using Pragmatic Research Methods to Address a Global Pandemic: Lessons Learned from NACMI

The COVID-19 pandemic presented a unique opportunity for researchers to use pragmatic methods to obtain information about the virus and promptly disseminate the findings for healthcare providers to utilize them. One such approach to studying patients who presented with COVID-19 and ST-Elevation Myocardial Infarction (STEMI) was the development of the North American COVID-19 STEMI (NACMI) registry. By leveraging social media and communication platforms such as WhatsApp, cardiologists across North America initiated the development of the NACMI registry within 14 days—an accomplishment which was unfathomable pre-pandemic. This was followed by ethics approval through a centralized Institutional Review Board, which led to patient consent being waived, and the use of a single coordinating center (Minneapolis Heart Institute Foundation) responsible for sites, database, and analysis. The NACMI findings were published rapidly across various media, including high-profile cardiovascular journals. Early results demonstrated an elevated mortality rate, disproportionality based on race, and angiographic differences showing unique mechanistic differences in the etiology of STEMI due to COVID-19. Additionally, NACMI provided early evidence that vaccination for COVID-19 reduced the risk of mortality in those with COVID-19 and STEMI. NACMI provided a framework for informing cardiologists early on regarding the optimal treatment of STEMI in patients with COVID-19. The lessons learned may be valuable for developing policy in future pandemics to treat patients using real-world application and routinely collected variables.