Relationship Between Myocardial Injury During Index Hospitalization for SARS-CoV-2 Infection and Longer-Term Outcomes

• Main Authors: Atri, D.S (Author), Baden, L.R (Author), Bhatt, A.S (Author), Bhatt, D.L (Author), Blankstein, R. (Author), Di Carli, M. (Author), Feeley, M. (Author), Karlson, E.W (Author), Kim, A. (Author), Mitre, X. (Author), Nauffal, V. (Author), Oganezova, K. (Author), Rutherford, H. (Author), Siddiqi, H. (Author), Varshney, A.S (Author), Vieira, J. (Author), Weber, B. (Author), Woolley, A.E (Author), Zhou, G. (Author)
• Format: Article
• Language: English
• Published: American Heart Association Inc. 2022
• Subjects: adult; aged; Article; Biomarkers; blood; clinical feature; cognitive defect; cohort analysis; complication; coronavirus disease 2019; COVID-19; disease association; female; follow up; functional status; Heart Injuries; heart injury; heart muscle injury; hospitalization; Hospitalization; human; Humans; length of stay; Long covid; major clinical study; male; mortality rate; Outcomes; PASC; Prospective Studies; prospective study; risk factor; survival rate; therapy; treatment outcome; Treatment Outcome; troponin T; Troponin T
• Online Access: View Fulltext in Publisher

 BACKGROUND: Myocardial injury in patients with COVID-19 is associated with increased mortality during index hospitalization; however, the relationship to long-term sequelae of SARS-CoV-2 is unknown. This study assessed the relationship between myocardial injury (high-sensitivity cardiac troponin T level) during index hospitalization for COVID-19 and longer-term outcomes. METHODS AND RESULTS: This is a prospective cohort of patients who were hospitalized at a single center between March and May 2020 with SARS-CoV-2. Cardiac biomarkers were systematically collected. Outcomes were adjudicated and stratified on the basis of myocardial injury. The study cohort includes 483 patients who had high-sensitivity cardiac troponin T data during their index hospitalization. During index hospitalization, 91 (18.8%) died, 70 (14.4%) had thrombotic complications, and 126 (25.6%) had cardiovascular complications. By 12 months, 107 (22.2%) died. During index hospitalization, 301 (62.3%) had cardiac injury (high-sensitivity cardiac troponin T≧14 ng/L); these patients had 28.6%, 32.2%, and 33.2% mortality during index hospitalization, at 6 months, and at 12 months, respectively, compared with 4.1%, 4.9%, and 4.9% mortality for those with low-level positive troponin and 0%, 0%, and 0% for those with undetectable troponin. Of 392 (81.2%) patients who survived the index hospitalization, 94 (24%) had at least 1 readmission within 12 months, of whom 61 (65%) had myocardial injury during the index hospitalization. Of 377 (96%) patients who were alive and had follow-up after the index hospitalization, 211 (56%) patients had a documented, detailed clinical assessment at 6 months. A total of 78 of 211 (37.0%) had ongoing COVID-19– related symptoms; 34 of 211 (16.1%) had neurocognitive decline, 8 of 211 (3.8%) had increased supplemental oxygen requirements, and 42 of 211 (19.9%) had worsening functional status. CONCLUSIONS: Myocardial injury during index hospitalization for COVID-19 was associated with increased mortality and may predict who are more likely to have postacute sequelae of COVID-19. Among patients who survived their index hospitalization, the incremental mortality through 12 months was low, even among troponin-positive patients. © 2021 The Authors.