Interpretation of myocardial injury subtypes in COVID-19 disease per fourth version of Universal Definition of Myocardial Infarction

Abstract

Background

Application of the 4th version of Universal Definition of Myocardial Infarction (UDMI) to characterize rates and prognostic relevance of myocardial injury in COVID-19 disease.

Methods

This retrospective, single-centre observational study enrolled 104 patients hospitalized with SARS-CoV-2 infection. Kaplan–Meier analysis and multivariate Cox regression were used to identify influence of acute or chronic myocardial injury on a composite primary (mortality, incident acute respiratory distress syndrome, incident mechanical ventilation) and secondary endpoint (mortality, incident acute myocardial injury during hospitalization, incident venous thrombosis, pulmonary embolism or stroke).

Results

A total of 27 (26.0%) patients presented with chronic myocardial injury, and 19 (18.3%) with acute myocardial injury. 42 patients(40.4%) developed an incident myocardial injury during hospitalization. The presence of acute or chronic myocardial injury on admission and incident myocardial injury during hospitalization were associated with higher rates of endpoints. Independent predictors for the primary endpoint were higher severity stages according to Siddiqi et al. classification system and history of dyslipidaemia. Maximal hs-cTnT and D-dimer concentrations during hospitalization showed an association (r = 0.61).

Conclusions

Objective description of myocardial injury according to the 4th UDMI in the current COVID-19 pandemic is crucial in order to discriminate patients with acute myocardial infarction and acute, chronic or incident myocardial injury.

Keywords:

• Myocardial injury
• COVID-19
• SARS-CoV-2
• Universal Definition of Myocardial Infarction
• myocardial infarction

Authors’ contributions

CS, MMH, and EG conceived and designed the study. CS, MMH and EG managed the data, including quality control. EG, CS and MMH provided statistical advice on study design and analyzed the data. EG, CS and MB, KS, MP, LK, UM, PS and HK drafted the manuscript, and all authors contributed substantially to its revision. All authors take responsibility for the paper as a whole.

Acknowledgements

The authors gratefully acknowledge Amelie Werner, Elisabeth Mertz and Heidi Deigentasch for their assistance regarding data collection.

Disclosure statement

The authors have no conflicts of interest to declare that are relevant to the content of this article. MMH reports grants and personal fees from Roche Diagnostics, grants from Thermo Scientific, outside the submitted work. MB reports grants and non-financial support from AstraZeneca, non-financial support from Brahms Theramo Fisher, outside the submitted work. HK reports personal fees from AstraZeneca, personal fees from BayerVital, personal fees from Boehringer Ingelheim, personal fees from NovoNordisk, personal fees from Roche Diagnostics, outside the submitted work. EG reports personal fees from Roche Diagnostics, personal fees from Astra Zeneca, personal fees from Bayer Vital, personal fees from Boeringer Ingelheim, personal fees from Brahms Deutschland, personal fees from Daiichi Sankyo, grants from Deutsche Herzstiftung, outside the submitted work. All other authors have no conflicts of interest. The authors declare that they have no conflict of interest related to this manuscript.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.