Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.

Marco Schiavone,Gennaro Sardella,Giovanni B Forleo,Francesco Fedele,Stefano Carugo,Claudio Tondo,Massimo Galli,Massimo Mancone,Aaron V Kaplan,Andrea Giacomelli,Ardan M Saguner,Alessio Gasperetti,Maurizio Viecca,Mattia Busana,Cecilia Gobbi,Gianfranco Mitacchione,Spinello Antinori,Antonio L Bartorelli,Fırat Duru ,Giosuè Mascioli

doi:10.3390/jcm9103263

Abstract

Background: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Methods: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. Results: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Conclusions: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.

Highlights

In recent times, the available body of evidence assessing the novel Coronavirus disease (COVID-19) has led to a progressive steering from a lung-centered disease paradigm in favor of a systemic disease concept
Consecutive confirmed cases of COVID-19 admitted to four Italian institutions (Luigi Sacco Hospital, Milan, Italy; Policlinico Umberto I, Rome, Italy; Humanitas Gavazzeni Hospital, Bergamo, Italy; and Centro Cardiologico Monzino, Milan, Italy) between 23 February 2020 and 1 May 2020 were screened for enrolment
chronic coronary syndromes (CCS) patients were significantly older than no-CCS patients and presented with more CV risk factors

Summary

Introduction

The available body of evidence assessing the novel Coronavirus disease (COVID-19) has led to a progressive steering from a lung-centered disease paradigm in favor of a systemic disease concept. The presence of myocardial injury, defined as high-sensitivity cardiac troponin (hs-cTn) elevation, was described especially among most critically ill patients with COVID-19 [5,6,7]. In these reports, older patients with acute myocardial injury suffered from more cardiovascular (CV) comorbidities and faced less favorable prognosis [8], and biomarker elevation was present in patients without underlying obstructive coronary artery disease (CAD) [9]. Studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes

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