Abstract 10255: The Evolving Impact of Myocardial Injury in COVID-19 Patient Amid the Omicron Wave of the Pandemic

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) with evidence of myocardial injury, defined as troponin elevation, has been demonstrated to be associated with worse outcomes. The temporal changes in outcomes in these patients during various phases of the pandemic remain unclear. Hypothesis: We sought to evaluate outcomes during the Omicron phase compared to previous phases of the pandemic. Methods: We analyzed COVID-19-positive patients with myocardial injury who presented to the MedStar Health system (11 hospitals in Washington, DC and Maryland) during Phase 1 of the pandemic (March 1 - June 30, 2020), Phase 2 (October 1, 2020 - January 31, 2021) and Phase 3 (Omicron) (December 1, 2021 - March 31, 2022) comparing their characteristics and outcomes. The primary end point was in-hospital mortality. Results: The cohort included 2079 COVID-19-positive admitted patients for whom troponin-I or high-sensitive troponin was elevated (Phase 1: n=150, Phase 2: n=854, Phase 3 [Omicron]: n=1075). Baseline characteristics were overall similar. Inflammatory markers were significantly elevated in Phase 1 as compared to Phase 2 and the Omicron Phase. The use of remdesivir and dexamethasone was most seen in Phase 2. In the Omicron Phase, 52.6% of patients were fully vaccinated. In-hospital mortality although high was lower in the Omicron Phase as compared to Phase 1 and Phase 2 (23.3% vs. 59.3% vs. 28.1%; p<0.001). Those vaccinated demonstrated even more favorable outcomes as compared to those patients unvaccinated (18.3% vs 24.2%, p = 0.042). Conclusions: COVID-19 patients with elevated troponin during the Omicron Phase still have significant mortality rates despite overall improved outcomes when compared to the first and second waves of the pandemic. This improvement in outcomes could be attributed to the implementation of the COVID-19 vaccine, advances in available COVID-19 treatment options, provider experience with the novel disease and less virulent variants.