tetano
Editor, Senior Moderator
Am Heart J Plus
. 2022 Feb;14:100131.
doi: 10.1016/j.ahjo.2022.100131. Epub 2022 Apr 16.
Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19: A Danish nationwide registry-based cohort study
Christoffer Polcwiartek[SUP] 1 2 [/SUP], Maria L Krogager[SUP] 1 [/SUP], Mikkel P Andersen[SUP] 3 [/SUP], Jawad H Butt[SUP] 4 [/SUP], Jannik Pallisgaard[SUP] 5 [/SUP], Emil Fosbøl[SUP] 4 [/SUP], Morten Schou[SUP] 5 [/SUP], Deepak L Bhatt[SUP] 6 [/SUP], Avinainder Singh[SUP] 6 7 [/SUP], Lars Køber[SUP] 4 [/SUP], Gunnar H Gislason[SUP] 5 8 [/SUP], Casper N Bang[SUP] 9 [/SUP], Christian Torp-Pedersen[SUP] 1 3 [/SUP], Kristian Kragholm[SUP] 1 [/SUP], Manan Pareek[SUP] 3 5 6 7 [/SUP]
Affiliations
Abstract
Background: Although troponin elevation is associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19), prognostic implications of serial troponin testing are lacking. We investigated the association between serial troponin measurements and adverse COVID-19 outcomes.
Methods: Using Danish registries, we identified COVID-19 patients with a high-sensitivity troponin measurement followed by a second measurement within 1-24 h. All measurements during follow-up were also utilized in subsequent time-varying analyses. We assessed all-cause mortality associated with the absence/presence of myocardial injury (≥1 troponin measurement >99th percentile upper reference limit) and absence/presence of dynamic troponin changes (>20% relative change if first measurement elevated, >50% relative change if first measurement normal).
Results: Of 346 included COVID-19 patients, 56% had myocardial injury. Overall, 20% had dynamic troponin changes. In multivariable Cox regression models, myocardial injury was associated with all-cause mortality (HR = 2.56, 95%CI = 1.46-4.51), as were dynamic troponin changes (HR = 1.66, 95%CI = 1.04-2.64). We observed a low incidence of myocardial infarction (4%) and invasive coronary procedures (4%) among patients with myocardial injury.
Conclusions: Myocardial injury and dynamic troponin changes determined using serial high-sensitivity troponin testing were associated with poor prognosis among patients with COVID-19. The risk of developing myocardial infarction requiring invasive management during COVID-19 hospitalization was low.
Keywords: Coronavirus disease 2019; Myocardial injury; Outcomes; Troponin I; Troponin T.
. 2022 Feb;14:100131.
doi: 10.1016/j.ahjo.2022.100131. Epub 2022 Apr 16.
Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19: A Danish nationwide registry-based cohort study
Christoffer Polcwiartek[SUP] 1 2 [/SUP], Maria L Krogager[SUP] 1 [/SUP], Mikkel P Andersen[SUP] 3 [/SUP], Jawad H Butt[SUP] 4 [/SUP], Jannik Pallisgaard[SUP] 5 [/SUP], Emil Fosbøl[SUP] 4 [/SUP], Morten Schou[SUP] 5 [/SUP], Deepak L Bhatt[SUP] 6 [/SUP], Avinainder Singh[SUP] 6 7 [/SUP], Lars Køber[SUP] 4 [/SUP], Gunnar H Gislason[SUP] 5 8 [/SUP], Casper N Bang[SUP] 9 [/SUP], Christian Torp-Pedersen[SUP] 1 3 [/SUP], Kristian Kragholm[SUP] 1 [/SUP], Manan Pareek[SUP] 3 5 6 7 [/SUP]
Affiliations
- PMID: 35463196
- PMCID: PMC9013153
- DOI: 10.1016/j.ahjo.2022.100131
Abstract
Background: Although troponin elevation is associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19), prognostic implications of serial troponin testing are lacking. We investigated the association between serial troponin measurements and adverse COVID-19 outcomes.
Methods: Using Danish registries, we identified COVID-19 patients with a high-sensitivity troponin measurement followed by a second measurement within 1-24 h. All measurements during follow-up were also utilized in subsequent time-varying analyses. We assessed all-cause mortality associated with the absence/presence of myocardial injury (≥1 troponin measurement >99th percentile upper reference limit) and absence/presence of dynamic troponin changes (>20% relative change if first measurement elevated, >50% relative change if first measurement normal).
Results: Of 346 included COVID-19 patients, 56% had myocardial injury. Overall, 20% had dynamic troponin changes. In multivariable Cox regression models, myocardial injury was associated with all-cause mortality (HR = 2.56, 95%CI = 1.46-4.51), as were dynamic troponin changes (HR = 1.66, 95%CI = 1.04-2.64). We observed a low incidence of myocardial infarction (4%) and invasive coronary procedures (4%) among patients with myocardial injury.
Conclusions: Myocardial injury and dynamic troponin changes determined using serial high-sensitivity troponin testing were associated with poor prognosis among patients with COVID-19. The risk of developing myocardial infarction requiring invasive management during COVID-19 hospitalization was low.
Keywords: Coronavirus disease 2019; Myocardial injury; Outcomes; Troponin I; Troponin T.