Evolution of Management and Outcomes of Patients with Myocardial Injury During the COVID-19 Pandemic
Brian C Case1, Jonathan Abramowitz1, Corey Shea1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
Insights
Outcomes for COVID-19 patients with myocardial injury (troponin elevation) significantly improved over time. Later pandemic phases saw reduced in-hospital mortality and ICU admissions compared to the early phase.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Cardiac involvement, indicated by troponin elevation, is a known complication of coronavirus disease 2019 (COVID-19).
- Troponin elevation in COVID-19 patients is associated with poorer prognosis and increased mortality.
- The impact of accumulating experience and evolving treatment strategies on patient outcomes during the COVID-19 pandemic remains an area of investigation.
Purpose of the Study:
- To evaluate whether patient outcomes for COVID-19 with myocardial injury improved as healthcare experience with the pandemic accumulated.
- To compare characteristics and outcomes of COVID-19 patients with troponin elevation between the early and later phases of the pandemic.
Main Methods:
- Retrospective analysis of COVID-19-positive patients with elevated troponin levels admitted to the MedStar Health system.
- Comparison of patient cohorts from the
- Early Phase
- (March 1 - June 30, 2020) and the
- Later Phase
- (October 1, 2020 - January 31, 2021).
- Analysis of clinical characteristics, in-hospital mortality, intensive care unit (ICU) admission rates, mechanical ventilation needs, and rates of coronary angiography and percutaneous coronary intervention (PCI).
Main Results:
- A total of 788 patients were analyzed (167 in the Early Phase, 621 in the Later Phase).
- The Later Phase cohort exhibited significantly higher in-hospital mortality (50.3% vs. 24.6%), ICU admission rates (77.8% vs. 46.1%), and mechanical ventilation requirements (61.7% vs. 28%) compared to the Early Phase.
- Despite worse outcomes in the Later Phase, more Early Phase patients underwent coronary angiography (6% vs. 2.3%) and PCI (3% vs. 0.8%).
Conclusions:
- Treatment outcomes for COVID-19 patients with myocardial injury (troponin elevation) have significantly improved since the early stages of the pandemic.
- Potential contributing factors include increased provider experience, enhanced disease awareness, and advancements in therapeutic strategies.
- Despite improvements, COVID-19 continues to pose significant risks to cardiac health, necessitating ongoing research and optimized clinical management.
Abstract:
Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the "Early Phase" of the pandemic (March 1 - June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the "Later Phase" of the pandemic (October 1, 2020 - January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the "Early Phase" and 621 during the "Later Phase." Maximum troponin-I in the "Early Phase" was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the "Later Phase" (p = 0.553). In-hospital mortality was significantly higher in the "Later Phase" (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more "Early Phase" patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of "Early Phase" and 0.8% of "Later Phase" patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.
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