Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection.
Adolescent
Adult
Aged
Aged, 80 and over
COVID-19
Cardiovascular Diseases
/ complications
Comorbidity
Coronavirus Infections
/ complications
Electronic Health Records
Female
Heart Injuries
/ complications
Hospitalization
Humans
Incidence
Male
Middle Aged
Myocardial Infarction
/ complications
Myocardium
/ pathology
New York City
Pandemics
Pneumonia, Viral
/ complications
Prevalence
Risk Factors
Treatment Outcome
Troponin I
/ blood
Young Adult
COVID-19
coronavirus
myocardial injury
troponin
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
04 08 2020
04 08 2020
Historique:
received:
18
05
2020
accepted:
02
06
2020
pubmed:
11
6
2020
medline:
11
8
2020
entrez:
11
6
2020
Statut:
ppublish
Résumé
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. 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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 32517963
pii: S0735-1097(20)35552-2
doi: 10.1016/j.jacc.2020.06.007
pmc: PMC7279721
pii:
doi:
Substances chimiques
Troponin I
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
533-546Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001433
Pays : United States
Commentaires et corrections
Type : UpdateOf
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Published by Elsevier Inc.
Références
Cardiovasc Res. 2017 Dec 1;113(14):1708-1718
pubmed: 29016754
JAMA Cardiol. 2020 Jul 1;5(7):811-818
pubmed: 32219356
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Am Coll Cardiol. 2018 Oct 30;72(18):2231-2264
pubmed: 30153967
Am J Physiol Heart Circ Physiol. 2020 May 1;318(5):H1084-H1090
pubmed: 32228252
J Am Coll Cardiol. 2019 Jan 8;73(1):10-12
pubmed: 30621938
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Acta Anaesthesiol Taiwan. 2013 Sep;51(3):120-6
pubmed: 24148741
Infection. 2020 Oct;48(5):773-777
pubmed: 32277408
Eur Heart J. 2013 Sep;34(33):2636-48, 2648a-2648d
pubmed: 23824828
Pharmacol Ther. 2009 Apr;122(1):30-43
pubmed: 19318042
JAMA Cardiol. 2020 Jul 1;5(7):819-824
pubmed: 32219357
Am J Clin Pathol. 2020 May 5;153(6):725-733
pubmed: 32275742
Clin Infect Dis. 2020 Jul 28;71(15):896-897
pubmed: 32271368
N Engl J Med. 2020 Jun 18;382(25):2441-2448
pubmed: 32356628
Prog Cardiovasc Dis. 2020 May - Jun;63(3):390-391
pubmed: 32169400
N Engl J Med. 2020 Jun 18;382(25):2478-2480
pubmed: 32302081
Circulation. 2020 Jun 9;141(23):1930-1936
pubmed: 32243205
JAMA Cardiol. 2020 Jul 1;5(7):802-810
pubmed: 32211816
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
N Engl J Med. 2020 Jun 18;382(25):2431-2440
pubmed: 32356627
Eur J Heart Fail. 2020 May;22(5):911-915
pubmed: 32275347
Am J Cardiol. 2005 Sep 1;96(5):611-6
pubmed: 16125480
Circulation. 2020 May 19;141(20):1648-1655
pubmed: 32200663
JAMA Cardiol. 2020 Jul 1;5(7):831-840
pubmed: 32219363
JAMA. 2020 May 12;323(18):1769-1770
pubmed: 32208485