Key result
Significant myocardial injury, defined as troponin I >0.09 ng/mL, was associated with a more than three-fold increased risk of death (adjusted HR 3.23) compared to normal troponin levels in patients hospitalized with COVID-19.
Why the study?
The degree of myocardial injury, reflected by troponin elevation, and associated outcomes among hospitalized patients with COVID-19 in the US were unknown.
Does elevated troponin-I on admission predict mortality in patients hospitalized with COVID-19?
Cohort (n=2,736)
Yes
Does elevated troponin-I on admission predict mortality in patients hospitalized with COVID-19?
Hazard Ratio: 3.23 (95% CI 2.59–4.02)
Myocardial injury, reflected by elevated troponin on admission, is common among patients hospitalized with COVID-19 and is independently associated with a significantly increased risk of mortality.
Highlights troponin for prognostication in COVID-19; leaves open causality versus marker of severity.
STRUCTURED ABSTRACT Background The degree of myocardial injury, reflected by troponin elevation, and associated outcomes among hospitalized patients with Coronavirus Disease (COVID-19) in the US are unknown. Objectives 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 one of five Mount Sinai Health System hospitals in New York City between February 27th and April 12th, 2020 with troponin-I (normal value <0.03ng/mL) measured within 24 hours of admission were included (n=2,736). Demographics, medical history, admission labs, and outcomes were captured from the hospitals’ EHR. 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. Even small amounts of myocardial injury (e.g. troponin I 0.03-0.09ng/mL, n=455, 16.6%) were associated with death (adjusted HR: 1.77, 95% CI 1.39-2.26; P<0.001) while greater amounts (e.g. troponin I>0.09 ng/dL, n=530, 19.4%) were associated with more pronounced risk (adjusted HR 3.23, 95% CI 2.59-4.02). Conclusions Myocardial injury is prevalent among patients hospitalized with COVID-19, and is associated with higher risk of mortality. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation likely reflects non-ischemic or secondary myocardial injury. Unstructured Abstract Myocardial injury reflected as elevated troponin in Coronavirus Disease (COVID-19) is not well characterized among patients in the United States. We describe the prevalence and impact of myocardial injury among hospitalized patients with confirmed COVID-19 and troponin-I measurements within 24 hours of admission (N=2,736). Elevated troponin concentrations (normal <0.03ng/mL) were commonly observed in patients hospitalized with COVID-19, most often present at low levels, and associated with increased risk of death. Patients with cardiovascular disease (CVD) or risk factors for CVD were more likely to have myocardial injury. Troponin elevation likely reflects non-ischemic or secondary myocardial injury.
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Lala et al. (2020) conducted a cohort in COVID-19 (n=2,736). Elevated troponin I (>0.09 ng/mL) vs. Normal troponin I (<0.03 ng/mL) was evaluated on Death during hospitalization (HR 3.23, 95% CI 2.59-4.02). Significant myocardial injury, defined as troponin I >0.09 ng/mL, was associated with a more than three-fold increased risk of death (adjusted HR 3.23) compared to normal troponin levels in patients hospitalized with COVID-19.
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