Myocardial injury during COVID-19 hospitalization tied to mortality, long-term symptoms
Among patients hospitalized with COVID-19, myocardial injury as determined by high-sensitivity cardiac troponin T was linked to mortality and ongoing COVID-19 symptoms, researchers reported.
Brittany Weber, MD, PhD, cardiologist at Brigham and Women’s Hospital and instructor in medicine at Harvard Medical School, and colleagues conducted a prospective analysis of 483 patients (median age, 63 years; 51% women) who were admitted to Brigham and Women’s Hospital for COVID-19 and had high-sensitivity cardiac troponin T measured (Elecsys 2010 system, Roche Diagnostics) at admission from March to May 2020.
During the index hospitalization, 18.8% of patients died, 14.4% had thrombotic complications and 25.6% had CV complications, whereas at 1 year, 22.2% died, Weber and colleagues found.
Cardiac injury, defined as high-sensitivity cardiac troponin T of at least 14 ng/L, occurred in 62.3% of the cohort during index hospitalization, according to the researchers.
Cardiac injury and mortality
Patients with cardiac injury had higher rates of mortality at index hospitalization (28.6%) compared with those with low-level positive troponin (4.1%) and those with undetectable troponin (0%), Weber and colleagues wrote.
Similar mortality rates were observed at 6 months (cardiac injury, 32.2%; low-level positive troponin, 4.9%; undetectable troponin, 0%) and at 12 months (cardiac injury, 33.2%; low-level positive troponin, 4.9%; undetectable troponin, 0%), according to the researchers.
After adjustment for age, sex, CAD, hypertension, hyperlipidemia, HF and diabetes, cardiac injury was associated with elevated risk for mortality compared with undetectable troponin (HR = 13.76; 95% CI, 1.85-102.3; P = .01), but there was no difference in mortality risk between low-level positive troponin and undetectable troponin (HR = 2.31; 95% CI, 0.27-19.48; P = .44).
During index hospitalization, those who had cardiac injury were more likely to have infectious complications (adjusted OR = 7.6; 95% CI, 3.6-15.8), cardiac complications (aOR = 15.3; 95% CI, 6.3-37.1) and thrombotic complications (aOR = 6; 95% CI, 2.8-13.2) compared with those who did not, according to the researchers.
Among the 392 patients who survived their index hospitalization, 24% were readmitted at least once within 1 year and 65% of those patients had myocardial injury during index hospitalization, Weber and colleagues found.
Readmission within 1 year was more common in patients with cardiac injury compared with low-level positive troponin and undetectable troponin (64.9% vs. 21.3% vs. 13.8%, respectively; P = .01), but the difference was not significant after multivariable adjustment (HR = 1.5; 95% CI, 0.8-2.5; P = .23).
Among the 211 patients who were alive at 6 months and had a detailed clinical assessment at that time, 37% had ongoing COVID-19-related symptoms, 16.1% had neurocognitive decline, 3.8% required increased supplemental oxygen and 19.9% had worsening functional status, according to the researchers.
The presence of ongoing COVID-19-related symptoms at 6 months was more common in patients with cardiac injury compared with low-level positive troponin and undetectable troponin (56.4% vs. 30.7% vs. 12.8%, respectively), but the difference did not reach statistical significance, Weber and colleagues wrote.
“This study provides unique insights into the relationship between cardiovascular injury during the index hospitalization for patients with COVID-19 and longer-term outcomes,” Weber and colleagues wrote. “Patients with evidence of myocardial injury during index hospitalization had an increased risk of cardiac, thrombotic and infectious complications during the hospitalization and all-cause mortality. Furthermore, these patients had higher rates of hospital readmissions and post-acute sequelae of COVID-19 at 6 months, although this was not statistically significant. An additional unique aspect of our cohort findings is that even among those patients with positive troponins during their index hospitalization, the incremental mortality at 6 months and 1 year among COVID-19 survivors was low. These data suggest that patients who are hospitalized with COVID-19, even if critically ill, but survive the index hospitalization are likely to survive up to 1 year. Whether this trend is observed longer-term is not known and will be an important question to investigate as we gather longer-term data.”