Abstract
Background: Myocardial injury is frequently identified in patients with Coronavirus Disease 2019 (COVID-19). The incidence and outcome of myocardial injury at presentation and during the course of hospitalization for COVID-19 are uncertain. Methods: Consecutive adults (age ≥18) with COVID-19 admitted to a health care system with 4 large hospitals in New York between March 1st and April 16th, 2020 were identified. Initial and peak cardiac troponin (cTn) measurements were recorded. Myocardial injury was defined by cTn above the laboratory upper limit of normal. Thrombotic events, critical illness, and in-hospital mortality was determined. Results: Among 3,116 adults with COVID-19 and ≥1 cTn measurement, myocardial injury was present in 606 (19%) patients at hospital admission, with a median cTn of 0.10 ng/mL [range 0.04-91.8 ng/mL]. Patients with myocardial injury were older, more likely male, and more likely to have cardiovascular disease. Thrombotic events (38% vs. 10%, p<0.001; adjusted odds ratio [aOR] 3.54, 95 CI 2.91-4.53), critical illness (58% vs. 32%, p<0.001; aOR 1.55, 95% CI 1.22-1.90) and mortality (41% vs. 17%, p<0.001; aOR 1.67, 95% CI 1.31-2.15), were more frequent in patients with versus without myocardial injury at presentation. Myocardial injury based on the peak cTn during hospitalization was detected in 956 (31%) patients and was also associated with thrombotic events (36% vs. 7%, p<0.001; aOR 6.56, 95% CI 5.09-9.85), critical illness (67% vs. 24%, p<0.001; aOR 6.05, 95% CI 5.05-7.87), and mortality (43% vs. 13%, p<0.001; aOR 3.83, 95% CI 3.15-5.03) versus those without myocardial injury. Patients with the highest cTn had the greatest risk of adverse events (Figure). Conclusions: Myocardial injury was observed in 1 in ~5 patients with COVID-19 at hospital presentation, and 1 in ~3 based on the peak cTn. Initial and peak cTn measurements were markers of adverse outcomes. The optimal management of myocardial injury in COVID-19 requires further study.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
