Does elevated troponin signal increased mortality risk in COVID-19?

  • Lala A & al.
  • J Am Coll Cardiol
  • 5 Jun 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Mild myocardial injury is common in patients with COVID-19.
  • Higher troponin elevations correlate with higher mortality risk.

Why this matters

  • Case series have reported that cardiac injury is associated with COVID-19.
  • Little is known about how SARS-CoV-2 affects the heart and clinical outcomes.

Key results

  • Median age: 66.4 years.
  • 24% had a history of cardiovascular disease (CVD).
  • 36% had elevated troponin.
  • As troponin rose, so did illness severity as measured by CURB-65 scores.
  • Compared with patients with lower troponins, in patients with higher troponin elevations:
    • CVD prevalence was higher.
    • Levels of D-dimer, C-reactive protein, lactate dehydrogenase, and procalcitonin were higher.
  • Many patients with higher troponin levels did not show evidence of primary acute myocardial infarction.
  • Mortality vs troponin levels in reference range:
    • Troponin >0.03 to 0.09 ng/mL: adjusted HR, 1.75 (95% CI, 1.37-2.24).
    • Troponin >0.09 ng/mL: adjusted HR, 3.03 (95% CI, 2.42-3.80).

Study design

  • Retrospective 5-hospital study in New York City of COVID-19 in patients who underwent troponin I measurement within 24 hours of admission (n=2736).
  • Outcome: mortality.
  • Funding: NIH.

Limitations

  • Electrocardiograms were not reviewed.
  • Etiology of cardiac injury remains unclear.