Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection
Data
2020Autor
Lala, Anuradha
Johnson, Kipp W.
Januzz, James L.
Russak, Adam J.
Paranjpe, Ishan
Richter, Felix
Zhao, Shan
Somani, Sulaiman
Van Vleck, Tielman
Vaid, Akhil
Chaudhry, Fayzan
De Freitas, Jessica K.
Fayad, Zahi A.
Pinney, Sean P.
Levin, Matthew
Charney, Alexander
Bagiella, Emilia
Narula, Jagat
Glicksberg, Benjamin S.
Nadkarni, Girish
Mancini, Donna M.
Fuster, Valentin
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Resumo
Background: The degree of myocardial injury, as reflected by troponin elevation, and associated
outcomes among US hospitalized patients with Coronavirus Disease 2019 (COVID-19) are
unknown.
Objectives: To describe the degree of myocardial injury and associated outcomes in a large
hospitalized cohort with laboratory-confirmed COVID-19.
Methods: Patients with COVID-19 admitted to one of five Mount Sinai Health System hospitals
in New York City between February 27th and April 12th, 2020 with troponin-I (normal value
<0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics,
medical history, admission labs, and outcomes were captured from the hospitals’ EHR.
Results: The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD)
including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in
patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506
(18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin
concentrations. After adjusting for disease severity and relevant clinical factors, even small
amounts of myocardial injury (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were significantly
associated with death (adjusted HR: 1.75, 95% CI 1.37-2.24; P<0.001) while greater amounts
(e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were significantly associated with higher risk
(adjusted HR 3.03, 95% CI 2.42-3.80; P<0.001).
Conclusions: Myocardial injury is prevalent among patients hospitalized with COVID-19
however troponin concentrations were generally present at low levels. Patients with CVD are
more likely to have myocardial injury than patients without CVD. Troponin elevation among
patients hospitalized with COVID-19 is associated with higher risk of mortality.
Condensed Abstract (100/100 words): Myocardial injury reflected as elevated troponin in
Coronavirus Disease (COVID-19) is not well characterized among US patients. We describe the
prevalence of myocardial injury and its impact on outcomes among hospitalized patients with
confirmed COVID-19 who had troponin-I measurements within 24 hours of admission
(N=2,736). Elevated troponin concentrations (normal <0.03ng/mL) were commonly observed in
patients hospitalized with COVID-19, most often present at low levels, and associated with
increased risk of death. Patients with cardiovascular disease (CVD) or CVD risk factors were
more likely to have myocardial injury.
Palabras clave
Myocardial injury; Troponin; Coronavirus; COVID-19Link para o recurso
https://doi.org/10.1016/j.jacc.2020.06.007Collections
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