About Half of Patients Hospitalized With COVID-19 Have Myocardial Injury Linked to Worse Outcomes

A single high-sensitivity cardiac troponin T measurement may help risk stratify patients admitted to the hospital with COVID-19.

Patients with COVID-19 presenting at the hospital with high-sensitivity cardiac troponin T (hs-cTnT) <6 ng/L were associated with more favorable outcomes. These findings were presented during the American College of Cardiology (ACC) annual meeting held May 15 to 17, 2021, in Atlanta, Georgia.

Researchers from the Mayo Clinic conducted this retrospective multicenter, observational study. Patients (N=367) with COVID-19 who were measured for hs-cTnT for evidence of myocardial injury at 20 hospitals in the US were assessed for in-hospital and 30-day postdischarge mortality, respiratory failure, cardiac arrest, and shock.

Nearly half of patients (46%) exhibited evidence of myocardial injury. Most COVID-19-related myocardial injury was due to isolated injury (95%) and 5% were classified as myocardial infarction type 1 or 2.

Patients with myocardial injury had increased rates of in-hospital mortality (15% vs 3.5%; P <.0001) and postdischarge mortality (8.8% vs 1.1%; P =.0013).

Risk for the composite endpoint of major adverse events (mortality, respiratory failure, cardiac arrest, and shock) was increased among the myocardial injury cohort (35% vs 11%; adjusted odds ratio [aOR], 3.84; 95% CI, 2.00-7.36; P <.0001).

Independent predictors of the composite endpoint were baseline hs-cTnT (aOR, 1.003; 95% CI, 1.00-1.007; P =.047) and maximum hs-cTnT (aOR, 1.005; 95% CI, 1.001-1.009; P =.0012).

Patients who presented at the emergency department with hs-cTnT <6 ng/L had a lower risk for major adverse events with a negative predictive value of 94.9% (95% CI, 87.5% to 98.6%) and sensitivity of 93.1% (95% CI, 83.3% to 98.1%).

This study may have been limited by the small sample size and the lack of protocols of hs-cTnT assessment.

The study authors concluded that myocardial injury was common among patients hospitalized for COVID-19, occurring among nearly half of all patients. Myocardial injury had significant prognostic implications and patients with hs-cTnT ³6 ng/L were found to be associated with poorer clinical outcomes and increased rates of in-hospital and postdischarge mortality.


De Michieli L, Ola O, Knott JD, et al. High-sensitivity cardiac troponin T for the detection of myocardial injury and risk stratification in COVID-19. JACC. 2021;77(18):3145. doi:10.1016/S0735-1097(21)04500-9