The prognostic value of serial troponin measurements in patients admitted for COVID‐19

Nuzzi, Vincenzo; Merlo, Marco; Specchia, Claudia; Lombardi, Carlo Mario; Carubelli, Valentina; Iorio, Annamaria; Inciardi, Riccardo Maria; Bellasi, Antonio; Canale, Claudia; Camporotondo, Rita; Catagnano, Francesco; Dalla Vecchia, Laura Adelaide; Giovinazzo, Stefano; Maccagni, Gloria; Mapelli, Massimo; Margonato, Davide; Monzo, Luca; Oriecuia, Chiara; Peveri, Giulia; Pozzi, Andrea; Provenzale, Giovanni; Sarullo, Filippo; Tomasoni, Daniela; Ameri, Pietro; Gnecchi, Massimiliano; Leonardi, Sergio; Agostoni, Piergiuseppe; Carugo, Stefano; Danzi, Gian Battista; Guazzi, Marco; La Rovere, Maria Teresa; Mortara, Andrea; Piepoli, Massimo; Porto, Italo; Volterrani, Maurizio; Senni, Michele; Metra, Marco; Sinagra, Gianfranco

AIMS: Myocardial injury (MI) in coronavirus disease‐19 (COVID‐19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in‐hospital evolution of MI and its prognostic impact. METHODS AND RESULTS: We performed an analysis from an Italian multicentre study enrolling COVID‐19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in‐hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10–13.09, P = 0.035). CONCLUSIONS: In patients admitted for COVID‐19, re‐test MI on Day 2 provides a prognostic value. A non‐negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.