Prevalence and Impact of Myocardial Injury in Patients Hospitalized with COVID-19 Infection

ABSTRACT Importance: It is postulated that myocardial injury may be common in Coronavirus Disease (COVID-19) reflected by troponin elevation. The nature, degree and mechanism of myocardial injury in affected patients in the United States are unknown. Objective: To describe the severity and trends of myocardial injury in a large cohort of hospitalized patients with confirmed COVID-19. Design: Retrospective cohort study of data captured between February 27th and April 12th, 2020. Setting: Patients were admitted to one of five hospitals in the Mount Sinai Health System (MSHS) in New York City. Data was collected from the electronic health record (EHR) databases within the hospital system. Participants: We included all patients with confirmed COVID-19 admitted to the aforementioned hospitals during the study period who had at least one troponin-I measured within 24 hours of admission. Exposure(s) (for observational studies): SARS-CoV-2 infection as confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay of nasal and pharyngeal swabs. Main Outcome(s) and Measure(s): During the study period, 2736 patients met the inclusion criteria. Demographics, medical history, admission labs, and all troponin-I measurements during hospitalization were recorded for each patient. Admission troponin levels were characterized as mildly elevated (between one and three times the upper limit of normal) and elevated (above three times the upper limit of normal). Results: The median age was 66.4 years, with 59.6% men and 40.7% over age 70. In those patients with elevated troponins, cardiovascular disease (CVD) including coronary artery disease, atrial fibrillation, and heart failure, were more prevalent as were conditions of chronic kidney disease, hypertension and diabetes. Inflammatory markers were higher among patients with more substantial troponin elevations as well. Patients who had lower hemoglobin, hypo- or hypertension, or tachycardia generally presented with higher troponins. Conclusions and Relevance: Myocardial injury, manifesting as troponin elevation appears to be common among patients hospitalized with COVID-19 but present at generally low levels. Patients with a history of CVD are more likely to have myocardial injury than patients without CVD or risk factors for CVD. Troponin elevation among patients hospitalized with COVID-19 likely represents non-ischemic or secondary myocardial injury.