ESC 2021 | Acute and Chronic Myocardial Injury in COVID-19 Patients and Impact in Mortality

In patients hospitalized for COVID-19, both acute and chronic myocardial injury impact survival at 6 months. In addition, the risk does not disappear after the acute phase of the disease, instead it persists in the following months among those who survive. 

ESC 2021 | Injuria aguda y crónica por COVID-19 y su impacto en la mortalidad

This study was presented at the scientific sessions of ESC 2021 and was simultaneously published in the European Heart Journal – Quality of Care & Clinical Outcomes.

The type of myocardial injury was based on troponin level assessment between 48 and 72 hours of diagnose using the Fourth Universal Definition of Myocardial Infarction criteria. 

We are used to monitoring troponin levels in hospitalized patients regardless COVID-19, since it has shown prognostic value in critical patients. There is plenty of data in the literature to support this. What we were missing was a systematic assessment of the different elevation patterns on a large-scale study. 

This study identified 7,815 patients admitted to a large center in New York between February and October 2020. They had all been diagnosed with COVID-19. Troponin analysis was available in 4,695 cases (60%).

Myocardial injury was considered chronic when troponin was elevated on both first and subsequent assessments with ≤20% variation and was considered acute if markers resulted normal on first assessment and subsequently elevated with >50% variation, or cardiac troponin was elevated on both first and subsequent assessments with >20% variation.

Read also: ESC 2021 | GREENNESS: Surprising New Protective Factor against Cardiovascular Disease.

Based on these definitions, 6.8% of the population showed chronic myocardial injury, which was associated to more kidney and cardiac failure

On the other hand, nearly 25% of the population showed acute myocardial injury values, which was associated to tachypnoea, hypotension, lower O2 saturation and higher levels of inflammation markers. 

Global mortality rate was 23.6%. 

When we observe figures after 6 months, in patients with normal troponin levels mortality drops by almost half (13%). This is driven by a 43% rate between those presenting chromic myocardial injury (HR 4.17; CI 95% 3.44 to 5.06) and 47.3% of patients evolving with acute myocardial injury (HR 4.72; CI 95% 4.15 to 5.36).

Read also: ESC 2021 | STEP: Blood Pressure Values in the Elderly, A Never-Ending Debate.

After excluding the first 30 days, when events peak, risk of death was still significant after 6 months. 

This was true for both types of myocardial injury, with approximately three times higher mortality in the group with normal troponin levels. 

These study outcomes are of vital importance to cardiologists seeing as they will be in charge of monitoring these patients closely after discharge. 

Despite the limitations of being an observational retrospective study (with the consequent risk of overestimating the prevalence of myocardial injury) this is, for now, one of the best studies we have on the matter. 

esc2021types-of-myocardial-injury-and-mid-term-outcomes-in patients-with-COVID-19

Original Title: Types of myocardial injury and mid-term outcomes in patients with COVID-19.

Reference: Annapoorna Kini et al. Eur Heart J Qual Care Clin Outcomes. 2021 Aug 30;qcab053. Online ahead of print. doi: 10.1093/ehjqcco/qcab053. 


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Is the Booster Dose Against COVID-19 Effective for All Ages?

The answer is incontrovertible: it is undeniably effective. For all ages, the confirmed COVID19 and severe case rates were significantly lower for patients who...

Pfizer Booster Dose Efficacy against Omicron

The BNT162b2 vaccine (Pfizer/BioNTech) has previously shown a 95% efficacy against COVID-19. This efficacy has been changing with the surge of new variants and,...

Once Again, the Omicron Variant Tests the Limits of Healthcare Systems, But with Hope

The latest significant COVID-19 variant, the Omicron, is again pushing healthcare systems around the world onto the verge of collapse, having reached over 300...

The Most Read Articles of 2021: COVID-19

A new year is coming to an end and at SOLACI we are going over the most read studies on our website, on COVID-19. Follow...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...