Friday, June 12, 2020

122 CMAAO CORONA FACTS and MYTH BUSTER: Myocardial injury

122 CMAAO CORONA FACTS and MYTH BUSTER:  Myocardial injury

Dr K K Aggarwal
President CMAAO

946: Myocardial Injury Among Hospitalised Patients With COVID-19 Associated With Higher Risk of Death

DG News Myocardial injury is prevalent among patients hospitalised with coronavirus disease 2019 (COVID-19) and is associated with higher risk of mortality, according to a study published in the Journal of the American College of Cardiology.

Anu Lala, MD, Icahn School of Medicine at Mount Sinai, New York, New York: “We found that 36% of patients who were hospitalised with COVID-19 had elevated troponin levels and were at higher risk of death. These findings, which are consistent with reports from China and Europe, are important for clinicians. If COVID-19-positive patients arrive in the emergency room and their initial test results show troponin levels are elevated, doctors may be able to better triage these patients and watch over them more closely, but this remains a testable hypothesis.”

Researchers analysed electronic health records of nearly 3,000 adult patients with confirmed positive COVID-19 admitted to 5 New York City hospitals within the Mount Sinai Health System between February 27, 2020, and April 12, 2020. The median age for patients analysed was 66 years and about 60% were male. One-quarter of all patients self-identified as African American and 27% self-identified as Latino. Roughly 25% of the patients had a history of heart disease and 25% had cardiovascular disease risk factors.

All patients had a blood test for troponin levels within 24 hours of admission, of which 64% had normal levels (0.00-0.03 ng/mL), 17% had mild elevation (>0.03-0.09 ng/mL), and 19% had higher elevation (>0.09 ng/mL). Higher troponin levels were more prevalent in patients who were aged older than 70 years old and had previously known conditions including diabetes, hypertension, atrial fibrillation, coronary artery disease, and heart failure.

Patients with milder forms of myocardial injury were associated with lower likelihood of hospital discharge and a 75% higher risk of death compared with patients with normal levels.

Patients with higher troponin concentrations were associated with a 3 times higher risk of death compared with those with normal levels. When adjusting for relevant factors such as heart disease, diabetes, and hypertension, troponin was independently associated with risk of death. More specifically, heart injury seems to be a more important indicator in predicting risk of death than a history of heart disease.


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