Myocardial Injury Portends a Higher Risk of Mortality and Long-Term Cardiovascular Sequelae after Hospital Discharge in COVID-19 Survivors

Riccardo Rinaldi; Mattia Basile; Carmine Salzillo; Domenico Luca Grieco; Andrea Caffè; Carlotta Masciocchi; Livia Lilli; Andrea Damiani; Giulia La Vecchia; Giulia Iannaccone; Alice Bonanni; Gennaro De Pascale; Rita Murri; Massimo Fantoni; Giovanna Liuzzo; Tommaso Sanna; Massimo Massetti; Antonio Gasbarrini; Vincenzo Valentini; Massimo Antonelli; Filippo Crea; Rocco Antonio Montone; On Behalf Of The Gemelli Against Covid Group

doi:10.3390/jcm11195964

Myocardial Injury Portends a Higher Risk of Mortality and Long-Term Cardiovascular Sequelae after Hospital Discharge in COVID-19 Survivors

J Clin Med. 2022 Oct 10;11(19):5964. doi: 10.3390/jcm11195964.

Authors

Riccardo Rinaldi¹, Mattia Basile¹, Carmine Salzillo¹, Domenico Luca Grieco^{2

3}, Andrea Caffè¹, Carlotta Masciocchi⁴, Livia Lilli⁴, Andrea Damiani⁵, Giulia La Vecchia¹, Giulia Iannaccone¹, Alice Bonanni¹, Gennaro De Pascale^{2

3}, Rita Murri^{5

6}, Massimo Fantoni^{5

6}, Giovanna Liuzzo^{1

7}, Tommaso Sanna^{1

7}, Massimo Massetti^{1

7}, Antonio Gasbarrini⁸, Vincenzo Valentini⁹, Massimo Antonelli^{2

3}, Filippo Crea^{1

7}, Rocco Antonio Montone⁷, On Behalf Of The Gemelli Against Covid Group

Affiliations

¹ Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy.
² Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
³ Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
⁴ UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁵ Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁶ Clinic of Infectious Diseases, Catholic University of the Sacred Heart, 00168 Rome, Italy.
⁷ Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
⁸ Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
⁹ Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.

Abstract

Background: Cardiovascular sequelae after COVID-19 are frequent. However, the predictors for their occurrence are still unknown. In this study, we aimed to assess whether myocardial injury during COVID-19 hospitalization is associated to CV sequelae and death after hospital discharge. Methods: In this prospective observational study, consecutive patients who were admitted for COVID-19 in a metropolitan COVID-19 hub in Italy, between March 2021 and January 2022, with a ≥ 1 assessment of high sensitivity cardiac troponin I (hs-cTnI) were included in the study, if they were alive at hospital discharge. Myocardial injury was defined as elevation hs-cTnI > 99th percentile of the upper reference limit. The incidence of all-cause mortality and major adverse cardiovascular and cerebrovascular events (MACCE, including cardiovascular death, admission for acute or chronic coronary syndrome, hospitalization for heart failure, and stroke/transient ischemic attack) at follow-up were the primary outcomes. Arrhythmias, inflammatory heart diseases, and/or thrombotic disorders were analyzed as well. Results: Among the 701 COVID-19 survivors (mean age 66.4 ± 14.4 years, 40.2% female), myocardial injury occurred in 75 (10.7%) patients. At a median follow-up of 270 days (IQR 165, 380), all-cause mortality (21.3% vs. 6.1%, p < 0.001), MACCE (25.3% vs. 4.5%, p < 0.001), arrhythmias (9.3% vs. 5.0%, p = 0.034), and inflammatory heart disease (8.0% vs. 1.1%, p < 0.001) were more frequent in patients with myocardial injury compared to those without. At multivariate analysis, myocardial injury (HR 1.95 [95% CI:1.05−3.61]), age (HR 1.09 [95% CI:1.06−1.12]), and chronic kidney disease (HR 2.63 [95% CI:1.33−5.21]) were independent predictors of death. Myocardial injury (HR 3.92 [95% CI:2.07−7.42]), age (HR 1.05 [95% CI:1.02−1.08]), and diabetes (HR 2.35 [95% CI:1.25−4.43]) were independent predictors of MACCE. Conclusion: In COVID-19 survivors, myocardial injury during the hospital stay portends a higher risk of mortality and cardiovascular sequelae and could be considered for the risk stratification of COVID-19 sequelae in patients who are successfully discharged.

Keywords: COVID-19; long COVID; myocardial injury; prognosis.

Abstract

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