July 30, 2026Open Access
Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection
Key Result
Elevated troponin I (>0.09 ng/ml) was significantly associated with a higher risk of mortality (adjusted HR 3.03) compared to normal troponin levels in patients hospitalized with COVID-19.
Key Points
- The study aims to detail the prevalence of myocardial injury and its outcomes in hospitalized patients with COVID-19.
- Patients with COVID-19 admitted to 5 hospitals in New York City were included (n=2,736).
- Troponin-I levels were measured within 24 h of admission, with a normal value <0.03 ng/ml.
- Demographics and outcomes were analyzed using electronic health records.
- 18.5% of patients (n=506) died during hospitalization.
- 36% of patients (n=985) had elevated troponin concentrations.
- Troponin elevation was significantly associated with higher mortality risk: adjusted HR of 1.75 for minor elevation (p<0.001) and 3.03 for greater elevation (p<0.001).
Study Design
Type
Cohort (n=2,736)
Multicenter
Yes
PICO
P
Population
2,736 adults hospitalized with laboratory-confirmed COVID-19 and a troponin measurement within 24 hours of admission, followed for a median of 5.75 days.
E
Exposure / Comparator
Elevated troponin I (>0.09 ng/ml) vs Normal troponin I (0.00 to 0.03 ng/ml)
O
Primary Outcome
Mortality — HR 3.03 (2.42 to 3.80), p=<0.001
Main Result
Hazard Ratio: 3.03 (95% CI 2.42–3.8)
p-value: p=<0.001
Limitations
- Limitations inherent to the use of electronic health records for patient-level data without manual chart review verification
- Some patients had not completed their hospital course at the time of data freeze
- Use of anticoagulation and antiviral therapy was not included due to incomplete data
- Natriuretic peptide levels were not available for more than two-thirds of the study cohort
- Troponin concentrations were not available in 323 patients who had fewer comorbidities
- Not possible to ascertain mechanisms of death including cardiovascular and noncardiovascular causes
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 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 0.09 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.
Expert Takes3 quotes
1/3
“It's kind of scary, actually, how much the risk goes up with elevated troponin.”