Myocardial injury in hospitalized COVID-19 patients: a retrospective study, systematic review, and meta-analysis

• Published in: BMC cardiovascular disorders Vol. 21; no. 1; p. 626
• Main Authors: Changal, Khalid, Veria, Spiro, Mack, Sean, Paternite, David, Sheikh, Shoaib Altaf, Patel, Mitra, Mir, Tanveer, Sheikh, Mujeeb, Ramanathan, P Kasi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.12.2021; BioMed Central; BMC
• Subjects: Aged; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - complications; Clinical outcomes; Coronaviruses; COVID-19; COVID-19 - complications; Ejection fraction; Female; Heart failure; Hospitalization; Hospitals; Humans; Hypertension; Ischemia; Kidney diseases; Laboratories; Male; Meta-analysis; Middle Aged; Multivariate analysis; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial ischemia; Ohio; Patient outcomes; Patients; Population studies; Prognosis; Quantitative analysis; Regression analysis; Renal Insufficiency, Chronic - complications; Retrospective Studies; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Survival; Systematic review; Troponin I - blood; Ohio; United States; United States > US
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02450-3

The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. The current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S. In our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28-3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%. Hospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.