The evolution of management and outcomes of patients with myocardial injury during the COVID-19 pandemic

Abstract

Abstract Background Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation, and associated with worse prognosis as compared with patients without myocardial injury. Purpose We sought to evaluate if the outcomes of these patients has improved as experience accumulated during the pandemic. Methods We analyzed COVID-19-positive patients with the evidence of myocardial injury (defined as troponin elevation) who presented to our large US healthcare system in the northeast region during the “Early Phase” of the pandemic (March 1–June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the “Current Phase” of the pandemic (October 1, 2020–January 31, 2021). Results The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the “Early Phase” and 621 during the “Current Phase”. The cohort's mean age was 70.2±14.9 years; 54.3% were men (Figure 1). Maximum troponin-I in the “Early Phase” was 13.46±34.72 versus 11.21±20.57 in the “Current Phase” (p=0.553) In-hospital mortality was significantly higher (50.3%) in the “Early Phase” group compared to the “Current Phase” group (24.6%; p<0.001). Similarly, the incidence of intensive care unit admission (77.8% versus 46.1%; p<0.044) and requirement for mechanical ventilation (61.7% versus 28%; p<0.001) were higher in the “Early Phase” (Figure 2). In addition, 6% of those in the “Early Phase” underwent coronary angiography compared to 2.3% in the “Current Phase” (p=0.013). Finally, 3% of “Early Phase” and 0.8% of “Current Phase” patients underwent percutaneous coronary intervention (p=0.025). Conclusions Treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies and provider experience. Funding Acknowledgement Type of funding sources: None.