Abstract
IntroductionThe majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. patient population.MethodsThe current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S.ResultsIn our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28–3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%.ConclusionHospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.
Highlights
The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.)
Myocardial injury was defined using the fourth universal definition of myocardial infarction as below: Detection of a rise and/or fall of cTn with at least one value above the 99th percentile and myocardial oxygen supply and demand mismatch not related to coronary thrombosis, with a minimum of one of the following: clinical symptoms related to cardiac ischemia; electrocardiographic changes suggestive of ischemia; new and pathological Q waves; imaging suggestive of acute loss of viable myocardium, or incident regional wall motion abnormalities consistent with ischemia [8]
A total of 268 patients were included in this study at our health system in Toledo, Ohio, U.S Fifty-eight (22.4%) patients met the inclusion criteria of myocardial injury, and 210 patients were included in the no myocardial injury group
Summary
The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and not applicable to the U.S patient population. The COVID-19 pandemic continues to affect millions of people in the United States (U.S.) and across the world [1]. Myocardial injury, as reflected by an increase in the serum troponin level above the 99th percentile, has been found to be relatively common in hospitalized COVID-19. We carry out a systematic review of current U.S studies, summarize their findings, and perform a meta-analysis
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