Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.
Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.
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DOI：
10.3390/jcm9103263
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发表时间：
2020-10-12
影响因子：
3.9
通讯作者：
Forleo GB
中科院分区：
文献类型：
--
作者：
Schiavone M;Gasperetti A;Mancone M;Kaplan AV;Gobbi C;Mascioli G;Busana M;Saguner AM;Mitacchione G;Giacomelli A;Sardella G;Viecca M;Duru F;Antinori S;Carugo S;Bartorelli AL;Tondo C;Galli M;Fedele F;Forleo GB
背景资料：尽管已经发表了评估2019冠状病毒病（COVID-19）患者心血管合并症和心肌损伤的研究，但目前尚无针对慢性冠状动脉综合征（CCS）患者和非CCS患者心肌损伤临床结局的报告。方法：在这项研究中，对四个不同机构收治的连续COVID-19患者进行了入组筛查。患者被分为两组（CCS与无CCS）。与住院死亡率和相关预测因素的相关性代表了主要的研究结果;心肌损伤及其预测因素被认为是次要结果。结果：共入组674例COVID-19患者，其中112例（16.6%）有CCS病史。入院时或住院期间高敏心肌肌钙蛋白（hs-cTn）升高证实，43.8%的CCS患者与14.4%的非CCS患者发生心肌损伤。CCS队列的死亡率几乎高出三倍。调整疾病严重程度后，心肌损伤与无CCS组的住院死亡率显著相关，但与CCS患者无关。结论：CCS和COVID-19患者的死亡率较高。心肌损伤可能是CCS患者和COVID-19的旁观者，而在没有已知CCS病史的患者中，心肌损伤在预测不良结局方面具有重要作用。
Background: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. Methods: In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. Results: A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Conclusions: Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.
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