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Inicio Medicina Clínica (English Edition) Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 in...
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Vol. 157. Issue 6.
Pages 274-280 (September 2021)
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Vol. 157. Issue 6.
Pages 274-280 (September 2021)
Original article
Characterization of myocardial injury in a cohort of patients with SARS-CoV-2 infection
Caracterización de la lesión miocárdica en una cohorte de pacientes infectados por el SARS-CoV-2
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Juan Caro-Codóna,
Corresponding author
juancarocd@gmail.com

Corresponding author.
, Juan R. Reya, Antonio Buñob, Angel M. Iniestaa, Sandra O. Rosilloa, Sergio Castrejon-Castrejona, Carlos Merinoa, Irene Marcoa, Luis A. Martineza, Jose M. Garcia-Veasa, Lorena Martin-Poloa, Laura Rodriguez-Soteloa, Marcel Martinez-Cossiania, Luis Gonzalez-Vallec, Alicia Herreroc, Esteban López-de-Sáa, Jose L. Merinoa, on behalf of the CARD-COVID Investigators
a Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
b Clinical Analytics Department, Hospital Universitario La Paz, Madrid, Spain
c Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
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Tables (3)
Table 1. Baseline characteristics among different categories of myocardial damage according to the criteria stated in the Fourth Definition of Myocardial Infarction.
Table 2. Clinical outcomes among different categories of myocardial damage according to the criteria stated in the Fourth Definition of Myocardial Infarction.
Table 3. Cox-proportional hazards model assessing the relationship between hs-TnI and mortality during follow-up adjusted for multiple relevant covariates.
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Additional material (1)
Abstract
Background

Myocardial injury has been identified as a common complication in patients with COVID-19. However, recent research has serious limitations, such as non-guideline definition of myocardial injury, heterogenicity of troponin sampling or very short-term follow-up. Using data from a large European cohort, we aimed to overcome these pitfalls and adequately characterize myocardial damage in COVID-19.

Methods

Consecutive patients with confirmed SARS-CoV-2 infection and available high-sensitive troponin I (hs-TnI), from March 1st to April 20th, 2020 who completed at least 1-month follow-up or died, were studied.

Results

A total of 918 patients (mean age 63.2±15.5 years, 60.1% male) with a median follow-up of 57 (49–63) days were included. Of these, 190 (20.7%) fulfilled strict criteria for myocardial injury (21.1% chronic, 76.8% acute non-ischemic, 2.1% acute ischemic). Time from onset of symptoms to maximum hs-TnI was 11 (7–18) days. Thrombotic and bleeding events, arrhythmias, heart failure, need for mechanical ventilation and death were significantly more prevalent in patients with higher hs-TnI concentrations, even without fulfilling criteria for myocardial injury. hs-TnI was identified as an independent predictor of mortality [HR 2.52 (1.57–4.04) per 5-logarithmic units increment] after adjusting for multiple relevant covariates.

Conclusion

Elevated hs-TnI is highly prevalent among patients with SARS-CoV-2 infection. Even mild elevations well below the 99th URL were significantly associated with higher rates of cardiac and non-cardiac complications, and higher mortality. Future research should address the role of serial hs-TnI assessment to improve COVID-19 prognostic stratification and clinical outcomes.

Keywords:
Troponin
Myocardial damage
Prognosis
Outcomes
Mortality
COVID-19
Resumen
Antecedentes

El daño miocárdico parece una complicación frecuente en pacientes con COVID-19. Sin embargo, la literatura al respecto presenta serias limitaciones, como definiciones incorrectas, heterogeneidad de las determinaciones de troponina o seguimientos cortos. Utilizando datos de una cohorte amplia, el objetivo del trabajo fue caracterizar adecuadamente el daño miocárdico en pacientes con COVID-19 utilizando una metodología adecuada.

Métodos

Se estudió a pacientes consecutivos con infección confirmada y determinaciones disponibles de troponina I de alta sensibilidad (hs-TnI), desde el 1 de marzo hasta el 20 de abril del 2020, que hubieran completado al menos un mes de seguimiento o fallecieran durante el periodo de estudio.

Resultados

Se incluyó a 918 pacientes (edad 63,2±15,5 años, 60,1% varones) con un seguimiento mediano de 57 (49-63) días. De estos, 190 (20,7%) cumplían criterios estrictos de lesión miocárdica (21,1% crónica, 76,8% aguda no isquémica, 2,1% aguda isquémica). El tiempo desde el inicio de los síntomas hasta la hs-TnI máxima fue de 11 (7-18) días. Los eventos trombóticos y hemorrágicos, las arritmias, la insuficiencia cardíaca, la necesidad de ventilación mecánica y la muerte fueron significativamente más frecuentes en pacientes con concentraciones elevadas de hs-TnI, incluso por debajo del nivel de lesión miocárdica. La hs-TnI resultó un predictor independiente de mortalidad (HR 2,52 [(1,57-4,04] por cada 5 unidades logarítmicas).

Conclusión

La hs-TnI elevada es altamente prevalente entre los pacientes con COVID-19. Elevaciones leves muy por debajo del límite para definir lesión miocárdica se asociaron con más complicaciones y mayor mortalidad. La determinación protocolizada de hs-TnI en estos enfermos podría mejorar su estratificación pronóstica y los resultados clínicos.

Palabras clave:
Troponina
Daño miocárdico
Pronóstico
Resultados
Mortalidad
COVID-19

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