Myocardial injury as a predictor of mortality and adverse outcomes in COVID-19

Background: The American College of Cardiology suggested physicians should only measure troponin and brain natriuretic peptide (BNP) if myocardial infarction or heart failure were suspected in people with COVID-19. We aimed to evaluate the use of biomarkers on admission to hospital and the impact on mortality and morbidity. Methods: Consecutive patients presenting with COVID-19(reverse transcription PCR positive) between Feb27-May20 2020 were included in this retrospective, observational, single-center study. Clinical information was collected on admission and during hospitalization by physicians and later analysed by specialist cardiology registrars. 1675 patients were PCR +ve with 1036 having a high sensitivity troponin T(hsTropT) on admission. 371(35.8%) patients were hs TropT negative(<15ng/L) and 664(64.1%) had evidence of myocardial injury on admission(hsTropT ≥15ng/L). Subsequently demographic details were compared, as well as primary outcomes of death, ICU admission and COVID severity. Secondary outcomes were ARDS, myocardial infarction (MI);comparison with other biomarkers: NT-proBNP, d-dimer, CRP,LDH and ferritin. Results: Demographic data revealed no significant increase in proportions of Black, Asian or ethnic minorities in the myocardial injury group, however, patients were older(74.9±13.5 v 54.7±13.7yrs;p <0.001) and had significantly more co-morbidities such as diabetes(37 v 13%), hypertension(34 v 29%), ischemic heart disease(16 v 2%), other cardiac conditions(59 v 5%), malignancy(11 v 1%), COPD(9 v 4%), CKD stage ≤3 (40 v 3%) (p <0.01). Mortality was significantly higher in the myocardial injury group, 302(45.5%) v 29(7.8%) p <0.001, as were secondary outcomes of critical COVID (47 v 19%;p<0.001), ARDS (20 v 4%;p<0.001), Type 1 MI (1.6 v 0.01%;p<0.01) and Type 2 MI (44 v 26%;p<0.001). Interestingly, ICU admission (19 v 23%;p=0.09), pulmonary embolism (11 v 6%;p=0.22), stroke (1.1 v 0.5%;p=0.05) did not reach significance. Analysis of bio-markers on admission (Fig 1.) demonstrated hs Trop T (AUC 0.75 CI 0.69-0.81) and NT-pro BNP (AUC 0.75 CI 0.69-0.81) had more sensitvity 83%;85% and specificty 52%;58%, respectively at predicting death than d-dimer, CRP, LDH and ferritin. Conclusion: Early detection of elevated hsTropT and NT-proBNP predicts mortality and morbidity in patient with COVID-19. Routine measurement of cardiac biomarkers should be considered in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification and guide monitoring. (Figure Presented).

TCT CONNECT-221 Primary PCI for STEMI During the COVID-19 Pandemic in London: A Systematic Analysis of Pathway Activation and Outcomes

Background: Coronavirus disease-2019 (COVID-19) poses a risk for health care workers necessitating modifications to existing medical pathways. In particular, managing patients with suspected COVID-19 represents a risk to the delivery of a primary percutaneous coronary intervention (PPCI) pathway where time-dependent revascularization is key. Methods: We sought to evaluate the effect of the COVID-19 pandemic on an established ambulance-triggered PPCI program involving 2 high-volume heart attack centers in London, United Kingdom. A systematic analysis was performed in patients with ST-segment elevation myocardial infarction undergoing PPCI comparing the COVID-19 pandemic period March 1, 2020, to April 30, 2020, with a control group from the previous year. Results: During the study period, admissions through the PPCI pathway decreased by 34%. The time from symptoms onset to first call for help (2020: 11 min vs. 2019: 12 min;p = 0.90) and from symptom onset to arrival at PPCI center (2020: 183 min vs. 2019: 178 min;p = 0.99) were comparable;however, the time from arrival at PPCI center to revascularization decreased (2020: 44 min vs. 2019: 53 min;p = 0.0004). In-hospital mortality during the study period was significantly lower (5% vs. 15%;p = 0.04). COVID-19–positive patients (n = 8) had higher rates of cardiogenic shock (25%), intensive care unit admission (50%), and inpatient mortality (38%). [Formula presented] Conclusion: Our data show that the modifications to the existing PPCI pathway were not associated with treatment delay or adverse outcome. The reduction in ST-segment elevation myocardial infarction presentations raises concern that patients may not be seeking appropriate medical attention for chest pain. Importantly, we demonstrate that PPCI can be delivered safely and efficiently during the COVID-19 pandemic. Categories: OTHER: COVID-19