Incidence of Myocardial Injury in COVID-19-Infected Patients: A Systematic Review and Meta-Analysis

Abstract

Introduction: The incidence of acute myocardial injury (AMI) among Coronavirus Disease 19 (COVID-19)-infected patients remain unclear. We aimed to conduct a systematic review and meta-analysis to further explore the incidence AMI in these patients. Methods: We comprehensively searched the MEDLINE, EMBASE and Cochrane databases from their inception to August 2020. The included studies were prospective or retrospective cohort studies that reported the event rate of AMI in COVID-19 patients. Data from each study were combined using random-effects to calculate the pooled incidence with 95% confidence intervals. Results: We identified twenty-seven studies consisting of 8971 hospitalized COVID-19-infected patients. The study demonstrated that 20.0% (95% CI 16.1–23.8% with substantial heterogeneity (I2 = 94.9%)) of hospitalized COVID-19 patients had AMI. In addition, our meta-regression suggested that older age, male and comorbidities were associated with a higher risk of AMI. Conclusion: The incidence of COVID-19-related myocardial injury ranges from 16.1–23.8%. Further larger studies are anticipated, as the pandemic is still ongoing.

Symptoms, complications and management of long COVID: a review

“…COVID-19 is a multi-systemic disease, which may occur with complications at presentation or developing during the acute phase of illness. These complications may be respiratory, 40 cardiovascular, [41][42][43][44][45] renal, [46][47][48] gastrohepatic, [49][50][51][52][53] thromboembolic, [54][55][56][57][58] neurological, 59-61 cerebrovascular [62][63][64] and autoimmune 13,65 among others.…”

COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges

“…Several systematic reviews and meta-analyses have reported their findings on ACI in COVID-19 patients (Table 1). 4,[20][21][22][23][24][25][26][27][28][29][30] A systematic review of 8 studies comprising 1,229 patients showed that the frequency of ACI was 16% (95% CI: 9%-27%), albeit with high (93%) heterogeneity among the studies. 4 A metaanalysis of 16 studies comprising 2224 patients indicated that the incidence of ACI was 24.4% in hospitalized COVID-19 patients.…”

“…37 In addition, advanced age, coagulopathy, acute respiratory distress syndrome (ARDS), and other comorbidities are associated with increased risk of in-hospital mortality in COVID-19 patients with ACI. 30,38 Pre-existence of heart failure and hypertension, and high cardiac biomarkers correlate with worse outcomes. 29…”

Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression

“…Different works of the literature showed that there is a strong correlation between acute myocardial Injury and COVID-19 infection. New studies are being published from around the globe but the link between acute myocardial injury and COVID-19, the prevalence, reliability of diagnostic modalities, independent predictors, and clinical outcomes are still uncertain and a topic of debate [ 22 , 24 , 26 , [32] , [33] , [34] , [35] , 41 , 44 , 50 , 53 , [57] , [58] , [59] , 62 , 76 , [81] , [82] , [83] , [84] , [85] ].…”

“…Our meta-analysis revealed that the pooled prevalence of acute myocardial injury in patients with COVID-19 was 22.33 (95 % CI: 17.86 to 26.81) which is relatively higher than other meta-analyses by Prasitlumkum et al and Alzahrani et al, 20.0 % (95 % CI 16.1–23.8 %) and 20.62 respectively. This discrepancy might be related with inclusion of few studies and study setting where these authors included studies conducted mainly in china with Twenty-seven and nine studies respectively [ 81 , 83 ]. However, a meta-analysis by Zou et al including sixteen studies where fourteen of them were from China showed higher incidence of acute myocardial infarction (24.4 %) among COVID-19 patients [ 90 ].…”