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

• Published in: Journal of the American Heart Association 2022-01, Vol.11 (1), p.e022010-e022010
• Main Authors: Weber, Brittany, Siddiqi, Hasan, Zhou, Guohai, Vieira, Jefferson, Kim, Andy, Rutherford, Henry, Mitre, Xhoi, Feeley, Monica, Oganezova, Karina, Varshney, Anubodh S, Bhatt, Ankeet S, Nauffal, Victor, Atri, Deepak S, Blankstein, Ron, Karlson, Elizabeth W, Di Carli, Marcelo, Baden, Lindsey R, Bhatt, Deepak L, Woolley, Ann E
• Format: Article
• Language: English
• Subjects: biomarkers; COVID-19 - complications; COVID-19 - therapy; COVID‐19; Heart Injuries - epidemiology; Hospitalization; Humans; long covid; Original Research; outcomes; PASC; Prospective Studies; Treatment Outcome; troponin T; Troponin T - blood
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.022010

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.