Original Investigation
Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection

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Abstract

Background

The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among U.S. hospitalized patients with coronavirus disease-2019 (COVID-19) are unknown.

Objectives

The purpose of this study was 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 1 of 5 Mount Sinai Health System hospitals in New York City between February 27, 2020, and April 12, 2020, with troponin-I (normal value <0.03 ng/ml) measured within 24 h of admission were included (n = 2,736). Demographics, medical histories, admission laboratory results, and outcomes were captured from the hospitals’ electronic health records.

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 to 0.09 ng/ml; n = 455; 16.6%) were significantly associated with death (adjusted hazard ratio: 1.75; 95% CI: 1.37 to 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 to 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.

Key Words

coronavirus
COVID-19
myocardial injury
troponin

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
AF
atrial fibrillation
ARB
angiotensin II receptor blocker
CAD
coronary artery disease
CKD
chronic kidney disease
COVID-19
coronavirus disease-2019
CVD
cardiovascular disease
DM
diabetes mellitus
EHR
electronic health records
HF
heart failure
HTN
hypertension
MSHS
Mount Sinai Health System
SARS-CoV-2
severe acute respiratory syndrome-coronavirus-2

Cited by (0)

This work was supported by U54 TR001433-05, National Center for Advancing Translational Sciences, National Institutes of Health. Dr. Januzzi is a Trustee of the American College of Cardiology; has received grant support from Novartis Pharmaceuticals and Abbott Diagnostics; has received consulting income from Abbott, Janssen, Novartis, MyoKardia, and Roche Diagnostics; and has participated in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, CVRx, Janssen, and Takeda. Dr. Pinney has received consulting fees from Abbott, CareDx, Medtronic, and Procyrion. Dr. Fayad has received consulting fees from Alexion and GlaxoSmithKline; has received research funding from Daiichi-Sankyo, Amgen, Bristol-Myers Squibb, and Siemens Healthineers; has received financial compensation as a board member and advisor to Trained Therapeutix Discovery; and owns equity in Trained Therapeutix Discovery as cofounder. Dr. Nadkarni has received consulting fees from AstraZeneca, Reata, BioVie, and GLG Consulting; has received financial compensation as a scientific board member and advisor to RenalytixAI; and owns equity in RenalytixAI and Pensieve Health as a cofounder. Dr. Johnson has received personal fees from Tempus Labs; and holds equity in Tempus Labs and Oova. Dr. Van Vleck has received financial compensation as a consultant for Clinithink, Ltd., the developer of the natural language processing software utilized in this study; and owns equity in Clinithink, a privately traded company. Dr. Lala has received speaker honoraria from Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Patrick O'Gara, MD, served as Guest Associate Editor for this paper. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

∗

Drs. Lala and Johnson contributed equally to this work.

†

Drs. Mancini and Fuster contributed equally to and jointly supervised this work.

Published by Elsevier on behalf of the American College of Cardiology Foundation