Clinical significance of coronavirus disease 2019 in hospitalized patients with myocardial injury.

ABSTRACT

BACKGROUND: The clinical significance of Coronavirus disease 2019 (COVID-19) as an associate of myocardial injury is controversial. HYPOTHESIS: Type 2 MI/Myocardial Injury are associated with worse outcomes if complicated by COVID-19. METHODS: This longitudinal cohort study involved consecutive patients admitted to a large urban hospital. Myocardial injury was determined using laboratory records as ≥1 hs-TnI result >99th percentile (male >34 ng/L; female >16 ng/L). Endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and COVID-19 determined using PCR. Outcomes of patients with myocardial injury with and without COVID-19 were assessed. RESULTS: Of 346 hospitalized patients with elevated hs-TnI, 35 (10.1%) had laboratory-confirmed COVID-19 (median age [IQR]; 65 [59-74]; 64.8% male vs. COVID-19 negative 74 [63-83] years; 43.7% male). Cardiac endotypes by COVID-19 status (yes vs. no) were Type 1 MI (0 [0%] vs. 115 [100%]; p < .0005), Type 2 MI (13 [16.5%] vs. 66 [83.5%]; p = .045), and non-ischemic myocardial injury (cardiac 4 [5.8%] vs. 65 [94.2%]; p = .191, non-cardiac19 [22.9%] vs. 64 [77.%]; p < .0005). COVID-19 patients had less comorbidity (median [IQR] Charlson Comorbidity Index 3.0 [3.0] vs. 5.0 [4.0]; p = .001), similar hs-TnI concentrations (median [IQR] initial 46 [113] vs. 62 [138]; p = .199, peak 122 [474] vs. 79 [220] ng/L; p = .564), longer admission (days) (median [IQR] 14[19] vs. 6[12]; p = .001) and higher in-hospital mortality (63.9% vs. 11.3%; OR = 13.2; 95%CI 5.90, 29.7). CONCLUSIONS: Cardiac sequelae of COVID-19 typically manifest as Non-cardiac myocardial injury/Type 2MI in younger patients with less co-morbidity. Paradoxically, the admission duration and in-hospital mortality are increased.