Utility of cardiac bioenzymes in predicting cardiovascular outcomes in SARS-CoV-2

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 ¼ 2,736).Demographics, medical histories, admission laboratory results, and outcomes were captured from the hospitals' electronic health records. RESULTSThe 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 ¼ 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 ¼ 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.