Myocardial Injury Predicts Risk of Short-Term All-Cause Mortality in Patients With COVID-19: A Dose–Response Meta-Analysis

Abstract

ObjectivePredictive value of myocardial injury as defined by elevated cardiac tropnins (cTns) in patients with COVID-19 has not been fully investigated. We performed a meta-analysis to evaluate the dose–response relationship between myocardial injury and short-term all-cause mortality.MethodsPubmed, Embase, and the Cochrane Library database were searched for all the studies which evaluated the relationship between cTns and the risk of short-term all-cause mortality in patients with COVID-19.ResultsCompared with patients without myocardial injury, the group with elevated cTns was associated with increased short-term mortality (11 studies, 29,128 subjects, OR 3.17, 95% CI 2.19–4.59, P = 0.000, I2 = 92.4%, P for heterogeneity 0.00). For the dose–response analysis, the elevation of cTns 1 × 99th percentile upper reference limit (URL) was associated with increased short-term mortality (OR 1.99, 95% CI 1.53–2.58, P = 0.000). The pooled OR of short-term mortality for each 1 × URL increment of cTns was 1.25 (95% CI 1.22–1.28, P = 0.000).ConclusionWe found a positive dose–response relationship between myocardial injury and the risk of short-term all-cause mortality, and propose elevation of cTns > 1 × 99th percentile URL was associated with the increased short-term risk of mortality.

Comparison of Incidence and Prognosis of Myocardial Injury in Patients with COVID-19-Related Respiratory Failure and Other Pulmonary Infections: A Contemporary Cohort Study

“…During the early stages of the pandemic, an alarming incidence of myocardial injury was detected among critically ill COVID-19 patients [2][3][4][5][6], leading to the elaboration of hypotheses to explain this incidence. Among them, it was proposed that pulmonary and cardiovascular damage could be mediated by a functional cell entry receptor of SARS-CoV-2, a type 2 Angiotensin Converting Enzyme receptor (ACE2), which is abundantly expressed on the surface of cells in the lungs and cardiovascular system [19].…”

“…Myocardial injury, defined as an elevated serum troponin level higher than the 99th percentile of a reference population, is a common finding in hospitalized COVID-19 patients [1]. Previous studies have reported the frequency of myocardial injury in COVID-19 patients ranges from 9.2 to 63.5% [2][3][4][5][6], with a well-established association with worse outcomes and increased mortality [2][3][4].…”

Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography

“…Furthermore, an increasing amount of data suggests that during COVID-19, not only is the respiratory system involved but data also demonstrate that the cardiovascular system may be affected which can lead to myocardial injury. These patients tend to have a significantly worse prognosis than those without the myocardial injury ( 6 – 8 ). So far, it has been proven that the inflammatory and immune response due to viral infection has also had a role in the pathogenesis of an acute MI ( 9 , 10 ).…”

Myocardial Injuries in COVID-19: More Questions Than Answers

“…However, we do know that the short-term cardiovascular effects on the long-term consequences in COVID-19 patients are related to myocardial injuries detected in the acute phase [ 12 , 13 ]. It is essential to recognise that, in some cases, a myocardial injury will persist once the acute phase of the infection has passed [ 14 ].…”