Types of myocardial injury and mid-term outcomes in patients with COVID-19

Annapoorna Kini, Davide Cao, Matteo Nardin, Samantha Sartori, Zhongjie Zhang, Carlo Andrea Pivato, Mauro Chiarito, Johny Nicolas, Yuliya Vengrenyuk, Parasuram Krishnamoorthy, Samin K. Sharma, George Dangas, Valentin Fuster, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Aims: To evaluate the acute and chronic patterns of myocardial injury among patients with coronavirus disease-2019 (COVID-19), and their mid-term outcomes. Methods and results: Patients with laboratory-confirmed COVID-19 who had a hospital encounter within the Mount Sinai Health System (New York City) between 27 February 2020 and 15 October 2020 were evaluated for inclusion. Troponin levels assessed between 72 h before and 48 h after the COVID-19 diagnosis were used to stratify the study population by the presence of acute and chronic myocardial injury, as defined by the Fourth Universal Definition of Myocardial Infarction. Among 4695 patients, those with chronic myocardial injury (n = 319, 6.8%) had more comorbidities, including chronic kidney disease and heart failure, while acute myocardial injury (n = 1168, 24.9%) was more associated with increased levels of inflammatory markers. Both types of myocardial injury were strongly associated with impaired survival at 6 months [chronic: hazard ratio (HR) 4.17, 95% confidence interval (CI) 3.44-5.06; acute: HR 4.72, 95% CI 4.14-5.36], even after excluding events occurring in the first 30 days (chronic: HR 3.97, 95% CI 2.15-7.33; acute: HR 4.13, 95% CI 2.75-6.21). The mortality risk was not significantly different in patients with acute as compared with chronic myocardial injury (HR 1.13, 95% CI 0.94-1.36), except for a worse prognostic impact of acute myocardial injury in patients <65 years of age (P-interaction = 0.043) and in those without coronary artery disease (P-interaction = 0.041). Conclusion: Chronic and acute myocardial injury represent two distinctive patterns of cardiac involvement among COVID-19 patients. While both types of myocardial injury are associated with impaired survival at 6 months, mortality rates peak in the early phase of the infection but remain elevated even beyond 30 days during the convalescent phase.

Original languageEnglish
Pages (from-to)438-446
Number of pages9
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume7
Issue number5
DOIs
StatePublished - 1 Nov 2021

Keywords

  • COVID-19
  • Coronavirus
  • Myocardial injury
  • Troponin

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