tetano
Editor, Senior Moderator
ESC Heart Fail
. 2021 Jul 8.
doi: 10.1002/ehf2.13462. Online ahead of print.
The prognostic value of serial troponin measurements in patients admitted for COVID-19
Vincenzo Nuzzi[SUP] 1 [/SUP], Marco Merlo[SUP] 1 [/SUP], Claudia Specchia[SUP] 2 [/SUP], Carlo Mario Lombardi[SUP] 3 [/SUP], Valentina Carubelli[SUP] 3 [/SUP], Annamaria Iorio[SUP] 4 [/SUP], Riccardo Maria Inciardi[SUP] 3 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Claudia Canale[SUP] 6 [/SUP], Rita Camporotondo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 8 [/SUP], Laura Adelaide Dalla Vecchia[SUP] 9 [/SUP], Stefano Giovinazzo[SUP] 6 [/SUP], Gloria Maccagni[SUP] 3 10 [/SUP], Massimo Mapelli[SUP] 11 12 [/SUP], Davide Margonato[SUP] 8 [/SUP], Luca Monzo[SUP] 13 14 [/SUP], Chiara Oriecuia[SUP] 2 3 [/SUP], Giulia Peveri[SUP] 2 12 [/SUP], Andrea Pozzi[SUP] 4 [/SUP], Giovanni Provenzale[SUP] 15 [/SUP], Filippo Sarullo[SUP] 16 [/SUP], Daniela Tomasoni[SUP] 3 [/SUP], Pietro Ameri[SUP] 6 [/SUP], Massimiliano Gnecchi[SUP] 7 17 [/SUP], Sergio Leonardi[SUP] 7 17 [/SUP], Piergiuseppe Agostoni[SUP] 11 12 [/SUP], Stefano Carugo[SUP] 15 [/SUP], Gian Battista Danzi[SUP] 10 [/SUP], Marco Guazzi[SUP] 18 19 [/SUP], Maria Teresa La Rovere[SUP] 20 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Massimo Piepoli[SUP] 21 22 [/SUP], Italo Porto[SUP] 6 [/SUP], Maurizio Volterrani[SUP] 23 [/SUP], Michele Senni[SUP] 4 [/SUP], Marco Metra[SUP] 3 [/SUP], Gianfranco Sinagra[SUP] 1 [/SUP]
Affiliations
Abstract
Aims: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.
Methods and results: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).
Conclusions: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.
Keywords: COVID-19; COVID-19 outcome; Myocardial injury; Troponin trajectories.
. 2021 Jul 8.
doi: 10.1002/ehf2.13462. Online ahead of print.
The prognostic value of serial troponin measurements in patients admitted for COVID-19
Vincenzo Nuzzi[SUP] 1 [/SUP], Marco Merlo[SUP] 1 [/SUP], Claudia Specchia[SUP] 2 [/SUP], Carlo Mario Lombardi[SUP] 3 [/SUP], Valentina Carubelli[SUP] 3 [/SUP], Annamaria Iorio[SUP] 4 [/SUP], Riccardo Maria Inciardi[SUP] 3 [/SUP], Antonio Bellasi[SUP] 5 [/SUP], Claudia Canale[SUP] 6 [/SUP], Rita Camporotondo[SUP] 7 [/SUP], Francesco Catagnano[SUP] 8 [/SUP], Laura Adelaide Dalla Vecchia[SUP] 9 [/SUP], Stefano Giovinazzo[SUP] 6 [/SUP], Gloria Maccagni[SUP] 3 10 [/SUP], Massimo Mapelli[SUP] 11 12 [/SUP], Davide Margonato[SUP] 8 [/SUP], Luca Monzo[SUP] 13 14 [/SUP], Chiara Oriecuia[SUP] 2 3 [/SUP], Giulia Peveri[SUP] 2 12 [/SUP], Andrea Pozzi[SUP] 4 [/SUP], Giovanni Provenzale[SUP] 15 [/SUP], Filippo Sarullo[SUP] 16 [/SUP], Daniela Tomasoni[SUP] 3 [/SUP], Pietro Ameri[SUP] 6 [/SUP], Massimiliano Gnecchi[SUP] 7 17 [/SUP], Sergio Leonardi[SUP] 7 17 [/SUP], Piergiuseppe Agostoni[SUP] 11 12 [/SUP], Stefano Carugo[SUP] 15 [/SUP], Gian Battista Danzi[SUP] 10 [/SUP], Marco Guazzi[SUP] 18 19 [/SUP], Maria Teresa La Rovere[SUP] 20 [/SUP], Andrea Mortara[SUP] 8 [/SUP], Massimo Piepoli[SUP] 21 22 [/SUP], Italo Porto[SUP] 6 [/SUP], Maurizio Volterrani[SUP] 23 [/SUP], Michele Senni[SUP] 4 [/SUP], Marco Metra[SUP] 3 [/SUP], Gianfranco Sinagra[SUP] 1 [/SUP]
Affiliations
- PMID: 34236135
- DOI: 10.1002/ehf2.13462
Abstract
Aims: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact.
Methods and results: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10-13.09, P = 0.035).
Conclusions: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.
Keywords: COVID-19; COVID-19 outcome; Myocardial injury; Troponin trajectories.