946: Myocardial Injury among Hospitalized Patients with COVID-19 Associated with Higher Risk of Death

Myocardial injury is prevalent among patients hospitalized with coronavirus disease 2019 (COVID-19) and is associated with higher risk of mortality, according to a study published in the Journal of the American College of Cardiology.

Anuradha Lala, MD, Icahn School of Medicine at Mount Sinai, New York, New York mentioned that they had found that 36% of patients hospitalized with COVID-19 had elevated troponin levels and were at higher risk of death. These findings are consistent with reports from China and Europe and are of significance for clinicians. “If COVID-19-positive patients arrive in the emergency room and their initial test results show troponin levels are elevated, doctors may be able to better triage these patients and watch over them more closely, but this remains a testable hypothesis,” said Dr Lala.

Researchers assessed the electronic health records of around 3,000 adult patients with confirmed COVID-19 who were admitted to 5 New York City hospitals within the Mount Sinai Health System from February 27 to April 12, 2020. The median age was 66 years and about 60% were male. One-quarter of all patients self-identified as African American and 27% self-identified as Latino. About 25% of the patients had a history of heart disease and 25% had cardiovascular disease risk factors.

All patients had a blood test for troponin levels within 24 hours of admission, of which 64% had normal levels (0.00-0.03 ng/mL), 17% had mild elevation (>0.03-0.09 ng/mL), and 19% had higher elevation (>0.09 ng/mL). Higher troponin levels appeared to be more prevalent among patients aged above 70 and having known conditions such as diabetes, hypertension, atrial fibrillation, coronary artery disease, and heart failure.

Patients with milder forms of myocardial injury were found to be linked with lower odds of hospital discharge and a 75% higher risk of death compared to patients with normal levels.

Patients with higher troponin concentrations had a 3 times higher risk of death compared with those with normal levels. After adjusting for relevant factors, including heart disease, diabetes, and hypertension, troponin was found to have an independent association with risk of death. More specifically, it appears that heart injury is a more important indicator in predicting risk of death than a history of heart disease.

[Reference: https://www.sciencedirect.com/science/article/abs/pii/S0735109720355522]

Dr KK Aggarwal

President CMAAO