tetano
Editor, Senior Moderator
J Am Coll Cardiol
. 2020 Jun 5;S0735-1097(20)35552-2.
doi: 10.1016/j.jacc.2020.06.007. Online ahead of print.
Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection
Anuradha Lala[SUP] 1 [/SUP], Kipp W Johnson[SUP] 2 [/SUP], James L Januzzi[SUP] 3 [/SUP], Adam J Russak[SUP] 4 [/SUP], Ishan Paranjpe[SUP] 5 [/SUP], Felix Richter[SUP] 2 [/SUP], Shan Zhao[SUP] 6 [/SUP], Sulaiman Somani[SUP] 5 [/SUP], Tielman Van Vleck[SUP] 5 [/SUP], Akhil Vaid[SUP] 2 [/SUP], Fayzan Chaudhry[SUP] 5 [/SUP], Jessica K De Freitas[SUP] 2 [/SUP], Zahi A Fayad[SUP] 7 [/SUP], Sean P Pinney[SUP] 8 [/SUP], Matthew Levin[SUP] 9 [/SUP], Alexander Charney[SUP] 10 [/SUP], Emilia Bagiella[SUP] 11 [/SUP], Jagat Narula[SUP] 8 [/SUP], Benjamin S Glicksberg[SUP] 12 [/SUP], Girish Nadkarni[SUP] 13 [/SUP], Donna M Mancini[SUP] 11 [/SUP], Valentin Fuster[SUP] 8 [/SUP], Mount Sinai Covid Informatics Center
Affiliations
Abstract
Background: The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among US hospitalized patients with Coronavirus Disease 2019 (COVID-19) are unknown.
Objectives: To describe the degree of myocardial injury and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19.
Methods: Patients with COVID-19 admitted to one of five Mount Sinai Health System hospitals in New York City between February 27th and April 12th, 2020 with troponin-I (normal value <0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics, medical history, admission labs, and outcomes were captured from the hospitals' EHR.
Results: The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD) including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506 (18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin concentrations. After adjusting for disease severity and relevant clinical factors, even small amounts of myocardial injury (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were significantly associated with death (adjusted HR: 1.75, 95% CI 1.37-2.24; P<0.001) while greater amounts (e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were significantly associated with higher risk (adjusted HR 3.03, 95% CI 2.42-3.80; P<0.001).
Conclusions: Myocardial injury is prevalent among patients hospitalized with COVID-19 however troponin concentrations were generally present at low levels. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation among patients hospitalized with COVID-19 is associated with higher risk of mortality.
Keywords: COVID-19; Coronavirus; Myocardial injury; Troponin.
. 2020 Jun 5;S0735-1097(20)35552-2.
doi: 10.1016/j.jacc.2020.06.007. Online ahead of print.
Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection
Anuradha Lala[SUP] 1 [/SUP], Kipp W Johnson[SUP] 2 [/SUP], James L Januzzi[SUP] 3 [/SUP], Adam J Russak[SUP] 4 [/SUP], Ishan Paranjpe[SUP] 5 [/SUP], Felix Richter[SUP] 2 [/SUP], Shan Zhao[SUP] 6 [/SUP], Sulaiman Somani[SUP] 5 [/SUP], Tielman Van Vleck[SUP] 5 [/SUP], Akhil Vaid[SUP] 2 [/SUP], Fayzan Chaudhry[SUP] 5 [/SUP], Jessica K De Freitas[SUP] 2 [/SUP], Zahi A Fayad[SUP] 7 [/SUP], Sean P Pinney[SUP] 8 [/SUP], Matthew Levin[SUP] 9 [/SUP], Alexander Charney[SUP] 10 [/SUP], Emilia Bagiella[SUP] 11 [/SUP], Jagat Narula[SUP] 8 [/SUP], Benjamin S Glicksberg[SUP] 12 [/SUP], Girish Nadkarni[SUP] 13 [/SUP], Donna M Mancini[SUP] 11 [/SUP], Valentin Fuster[SUP] 8 [/SUP], Mount Sinai Covid Informatics Center
Affiliations
- PMID: 32517963
- PMCID: PMC7279721
- DOI: 10.1016/j.jacc.2020.06.007
Abstract
Background: The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among US hospitalized patients with Coronavirus Disease 2019 (COVID-19) are unknown.
Objectives: To describe the degree of myocardial injury and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19.
Methods: Patients with COVID-19 admitted to one of five Mount Sinai Health System hospitals in New York City between February 27th and April 12th, 2020 with troponin-I (normal value <0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics, medical history, admission labs, and outcomes were captured from the hospitals' EHR.
Results: The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD) including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506 (18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin concentrations. After adjusting for disease severity and relevant clinical factors, even small amounts of myocardial injury (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were significantly associated with death (adjusted HR: 1.75, 95% CI 1.37-2.24; P<0.001) while greater amounts (e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were significantly associated with higher risk (adjusted HR 3.03, 95% CI 2.42-3.80; P<0.001).
Conclusions: Myocardial injury is prevalent among patients hospitalized with COVID-19 however troponin concentrations were generally present at low levels. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation among patients hospitalized with COVID-19 is associated with higher risk of mortality.
Keywords: COVID-19; Coronavirus; Myocardial injury; Troponin.