Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease
Marco Schiavone, Alessio Gasperetti, Massimo Mancone, Aaron V. Kaplan, Cecilia Gobbi, Giosuè Mascioli, Mattia Busana, Ardan M. Saguner, Gianfranco Mitacchione, Andrea Giacomelli, Gennaro Sardella, Maurizio Viecca, Fırat Duru, Spinello Antinori, Stefano Carugo, Antonio L. Bartorelli, Claudio Tondo, Massimo Galli, Francesco Fedele, Giovanni B. Forleo
Abstract
BACKGROUND: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. METHODS: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. RESULTS: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. CONCLUSIONS: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.