Abstract 15932: Clinical Significance of Coronavirus Disease 2019 in Hospitalized Patients With Myocardial Injury

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is a novel cause of myocardial injury. We investigated the clinical significance of COVID-19 in a population of hospitalized patients with myocardial injury. Methods: This was a prospective, longitudinal cohort study of hospitalized patients admitted to an urban academic medical center (catchment population 650,000) from March 1 - April 15, 2020. Consecutive patients with myocardial injury were identified using laboratory records by occurrence of ≥1 high-sensitivity troponin-I (hsTnI) result (Abbott ARCHITECT assay) >99 th percentile sex-specific upper reference limit (URL; male: >34 ng/L; female: >16 ng/L). Cardiac endotypes were defined according to the Fourth Universal Definition of Myocardial Infarction (MI) and laboratory data used to determine presence of COVID-19 infection by PCR. Outcomes of patients with myocardial injury with and without COVID-19 were assessed. Results: Of 390 hospitalized patients with elevated hsTnI, 346 were eligible for inclusion; 44 were excluded ( Duplicate: 2; Missing data: 41; Research patient: 1 ). 35 (10.1%) had laboratory-confirmed COVID-19 (COVID-19, yes vs no: median age [IQR]; 65 [59-74] vs 74 [63-83] years); 64.8% vs 43.7% male). Distribution of cardiac endotypes by COVID-19 status (yes vs no) were: Type 1 MI (0 [0%] vs 115 [100%]; p<0.0005), Type 2 MI (13 [16.5%] vs 66 [83.5%]; p=0.045), and non-ischemic myocardial injury (cardiac: 4 [5.8%] vs 65 [94.2%]; p=0.191, non-cardiac:19 [22.9%] vs 64 [77.%]; p<0.0005). Among all patients, those with COVID-19 had lower comorbidity burden (Charlson Comorbidity Index: 3.6 vs 5.1; p=0.002), similar average hsTnI concentrations (initial: 282 vs 316; p=0.853, peak: 560 vs 527ng/L; p=0.911), longer hospital stay (median [IQR]: 16 [20] vs 4 [9] days; p<0.0005) and higher inpatient mortality (66.7% vs 10.3%; OR=17.5; 95% CI: 8.00, 38.3). Respiratory failure requiring invasive ventilation occurred in 24 (68.6%) patients with COVID-19, whilst 18 (51.4%) and 21 (60%) required renal and/or circulatory support, respectively. Conclusion: Presence of both myocardial injury and COVID-19 is associated with high in-hospital mortality. Systemic consequences may be associated with higher mortality risk in this patient group.