COVID-19 and myocardial injury

Myocardial injury is common in patients admitted to hospital and has been estimated to occur in 8%-28% of patients admitted to hospital for coronavirus disease 2019 (COVID-19). Myocardial injury, which is defined as an elevated troponin level greater than the 99th upper limit of normal (ULN) may be due to ischemic or non-ischemic myocardial processes in COVID-19. Patients admitted to a critical care setting with COVID-19 have a higher rate of troponin elevation than those admitted to noncritical care settings, with observational studies reporting rates of troponin elevation of as much as 59% among patients who subsequently died. An elevated troponin level has also been shown to be predictive of mortality in critical care populations. Among other studies, a large retrospective cohort study involving a mixed ICU population of nearly 20 000 patients that used a previous acute coronary syndrome as an exclusion criterion showed that troponin elevation was an independent predictor of 30-day mortality when adjusted for illness severity (OR 1.82, 95% CI 1.62-2.04).