CLINICAL CHARACTERISTICS AND OUTCOMES OF COVID-19 PATIENTS WITH MYOCARDIAL INJURY: ONE-YEAR EXPERIENCE IN VANCOUVER, CANADA

Abstract

BACKGROUNDThe coronavirus 2019 (COVID-19) pandemic has caused unparalleled public health crisis worldwide. Myocardial injury in acutely ill hospitalized COVID-19 patients was associated with higher mortality and worse clinical outcomes. However, Canadian data on COVID-19 and myocardial injury is not available, and this is paramount to inform quality of care and direct efficient resource allocation.METHODS AND RESULTSWe conducted a retrospective study of patients with COVID-19 with myocardial injury admitted to two quaternary hospitals in British Columbia; Vancouver General Hospital between March 2020 – February, 2021 and St. Paul's Hospital between April – December, 2020. Myocardial injury was defined as troponin elevation greater than 99% upper limit of normal (normal troponin-I < 0.05 ng/L, troponin-T < 9 ng/L in female, < 14 ng/L in male) on admission or during hospitalization. Baseline demographics, laboratory results, and in-hospital outcomes were collected. The study was approved by our institutional research board. We included 494 COVID-19 patients in the study. The mean age was 63.4 years, and 58.9% were men. The prevalence of myocardial injury was 37.2%. Sixty-five patients (13.2%) died during hospitalization, of which 49 (9.9%) had myocardial injury. Patients with myocardial injury were more likely to require mechanical ventilation (31.1% vs. 12.1%, p < 0.001) and inotropic support (2.7% vs. 0.0%, p < 0.01). They had higher mortality (26.8% vs. 5.2%, p < 0.001), shock (11.5% vs. 1.0%, p < 0.00), cardiac arrest (15.3% vs. 2.9%, p < 0.001), heart failure (7.1% vs. 0.3%, p < 0.001), stroke (2.7% vs. 0.3%, p=0.019), and significantly longer length of hospitalization (23.7 vs. 13.6 days, p < 0.001) than patients without myocardial injury. Four myocardial injury patients were diagnosed with ST-elevation or non-ST elevation MI.CONCLUSIONMyocardial injury was frequent amongst hospitalized COVID-19 patients in British Columbia, and was associated with worse clinical outcomes and increased length of hospital stay.