Abstract 16790: Myocardial Injury is an Independent Predictor of Mortality in Patients With COVID-19

Abstract

Introduction: Recent reports on COVID-19 patients have shown that elevated troponin (Tn) levels on hospital admission are associated with adverse outcomes. However, no data exists on the predictive role of Tn kinetics parameters in COVID-19 patients. Aim: To analyze the incidence, clinical outcomes and predictors of Tn kinetics parameter, including rise/fall pattern and peak values, in a large cohort of COVID-19 hospitalized patients. Methods: All consecutive patients admitted to an urban tertiary-care health system between February and June 2020 with COVID-19 were included. Patients were grouped according to presence of myocardial injury defined as a high-sensitivity TnI level ≥0.1 ng/ml. A TnI level between 0.4-0.99 was defined as low positive range Tn elevation. Results: We included 5862 COVID-19 patients, 1558 (27%) of whom experienced myocardial injury. Advance age, male sex and higher comorbidity burden, including COPD, hypertension, CAD, atrial fibrillation, HF, CKD, and diabetes were more common in patients with myocardial injury. A total of 828/1558 (53.2%) of patients with myocardial injury died as compared to 634/4304 (14.7%) of those without (OR 6.57, 95% CI 5.76-7.48; p<0.001). After adjustment for baseline imbalances, myocardial injury remained an independent predictor of mortality (Adj.OR 5.26, 95% CI 4.57-6.05; p<0.001). Further stratification of patients into low positive range Tn elevation and myocardial injury groups showed a significant stepwise increase in mortality rates with increasing Tn values (Figure). Secondary endpoints, as shown in the Figure, occurred more frequently in patients with myocardial injury.Data on Tn kinetics parameters,such as rise/fall patterns,and associations with the outcomes will also be presented. Conclusions: Myocardial injury is an independent predictor of all-cause mortality in COVID-19 patients,with a stepwise increase in the risk of mortality reflecting increasing extent of myocardial damage.