Improvement of outcome prediction of hospitalized patients with COVID-19 by a dual marker strategy using high-sensitive cardiac troponin I and copeptin

Background: COVID-19 has been associated with a high prevalence of myocardial injury and increased cardiovascular morbidity. Copeptin, a marker of vasopressin release, has been previously established as a risk marker in both infectious and cardiovascular disease. Purpose: Investigate the prognostic impact of copeptin and high-sensitive cardiac troponin I (hs-cTnI) in COVID-19. Methods: This prospective, observational study of patients with laboratoryconfirmed COVID-19 infection was conducted from June 6th to November 26th, 2020 in a tertiary care hospital. Copeptin and hs-cTnI levels on admission were collected and tested for their association with the primary composite endpoint of ICU admission or 28-day mortality. Results: A total of 213 eligible patients with COVID-19 were included of whom 55 (25.8%) reached the primary endpoint. Median levels of copeptin and hs-cTnI at admission were significantly higher in patients with an adverse outcome (Copeptin 29.6 pmol/L, [IQR, 16.2-77.8] vs 17.2 pmol/L [IQR, 7.4-41.0] and hs-cTnI 22.8 ng/L [IQR, 11.5-97.5] vs 10.2 ng/L [5.5-23.1], P<0.001 respectively). ROC analysis demonstrated an optimal cutoff of 19.6 pmol/L for copeptin and 16.2 ng/L for hs-cTnI and an increase of either biomarker was significantly associated with the primary endpoint. The combination of raised hs-cTnI and copeptin yielded a superior prognostic value to individual measurement of biomarkers and was a strong prognostic marker upon multivariable logistic regression analysis (OR 4.274 [95% CI, 1.995-9.154], P<0.001). Addition of copeptin and hs-cTnI to established risk models improved C-statistics and net reclassification indices. Conclusion: The combination of raised copeptin and hs-cTnI upon admission is an independent predictor of deterioration (ICU admission) or 28-day mortality in hospitalized patients with COVID-19.

Course and therapy of cardiovascular diseases during COVID-19 pandemic

The COVID-19 pandemic poses a significant burden on national health-care systems with serious impact on patients with cardiovascular disease. The clinical course of COVID-19 is often aggravated by arterial or venous thromboembolic complications due to systemic inflammation and activation of the coagulation system. As a consequence of this prothrombotic milieu, thromboembolic complications occur in up to 30% of patients treated on the intensive care unit. Considering the high rates of thromboembolic complications, antithrombotic therapy plays a decisive role. Several recommendations from different expert panels have been published encouraging routine standard dose and increased intensity thromboprophylaxis with low-molecular weight heparin. Quantification of plasma levels of D-Dimer as a marker of the activated coagulation system and for risk stratification has been demonstrated to be of great value. Patients with cardiovascular diseases are a vulnerable patient cohort with an increased risk for an aggravated clinical course of the COVID-19 disease. Interventional treatment of patients with the diagnosis STEMI or high-risk NSTEMI has to be performed without delay regardless of the current state of the pandemic. Careful precautionary measures need to be implemented to protect the patients, but also the health-care personnel and the infrastructure of the hospital.

Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study.

BACKGROUND: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

COVID 19-what heart patients need to know

The patient forum of the European Society of Cardiology (ESC) has received multiple questions about the Coronavirus (COVID-19). Also the Acute CardioVascular Care Associaion (ACVC) of the ESC was frequently contacted with this respect. This manuscript summarized the most often asked questions with respect to COVID-19 and cardiovascular diseases and aims to provide helpful answers that were given by ESC and ACVC experts. ESC as well as ACVC have entitled J KARDIOL as well as other national cardiovascular journals to translate the content into national languages and offer this document to our colleagues in order to help answering difficult questions for our patients. The authors have done this by performing partially a relative liberal translation in order to reflect Austrian conditions.

Acute coronary syndromes and COVID-19 pandemic

The COVID-19 pandemic poses a threat to patients with acute coronary syndromes (ACS) and interventional cardiologists as well as other healthcare workers. The number of COVID-19 positive or suspected positive patients requiring hospital admission has overwhelmed many health systems and negatively affected standard of care for ACS patients in these countries. This manuscript aims to assist cardiologists in the invasive management of acute coronary syndrome (ACS) patients in the context of the COVID-19 pandemic. Modified diagnostic and treatment algorithms, which have been developed in countries heavily beaten by this unpredictable challenge, are discussed as are various clinical scenarios and management algorithms for patients with a confirmed or suspected COVID-19 infection presenting with ST segment elevation myocardial infarction (STEMI) or non-ST elevation ACS (NSTE-ACS). Further described topics include the need for re-organization of pre-hospital (STEMI networks) and in-hospital structures (emergency rooms and cardiac units), with examples coming from multiple European countries. Finally, this manuscript aims to help re-organizing of catheterization laboratory structures and personnel and to discuss measures for protection of healthcare providers involved with invasive procedures.