# COVID-19 and myocardial injury: Targeting elevated biomarkers for potential novel therapies

## TL;DR

This study shows that 10% of hospitalized patients with heart injury had COVID-19 as the main diagnosis, and high levels of certain heart and inflammation markers were linked to higher death rates, suggesting new therapies targeting these markers could help.

## Contribution

The study identifies elevated troponin and C-reactive protein as independent predictors of mortality in hospitalized patients with myocardial injury due to COVID-19.

## Key findings

- 10% of hospitalized patients with myocardial injury had newly diagnosed COVID-19 as the primary diagnosis.
- 42% of these patients died within six months, with age, peak troponin, and peak CRP as independent predictors of death.
- Targeting elevated oxidant stress and inflammatory biomarkers may offer novel therapies to improve outcomes in these patients.

## Abstract

•During the COVID-19 pandemic, the prevalence of COVID-19 as the primary diagnosis for hospitalized patients with myocardial injury was 10 %.••The mortality at 6 months was more than 40 % and independent predictors of death included age, peak troponin, and peak C-reactive protein levels.•Future studies should focus on targeting elevated oxidant stress and inflammatory biomarkers among these patients.

During the COVID-19 pandemic, the prevalence of COVID-19 as the primary diagnosis for hospitalized patients with myocardial injury was 10 %.

•The mortality at 6 months was more than 40 % and independent predictors of death included age, peak troponin, and peak C-reactive protein levels.

Future studies should focus on targeting elevated oxidant stress and inflammatory biomarkers among these patients.

The prevalence of COVID-19 as the primary diagnosis among hospitalized patients with myocardial injury has increased during the pandemic and targeting elevated oxidant stress and inflammatory biomarkers may offer a potential role for novel therapies to improve outcomes.

At a single VA Medical Center from January 1 through December 31, 2021, troponin assays from patients being evaluated in the Emergency Room for consideration of admission were analyzed and peak levels from each patient were considered abnormal if exceeding the Upper Reference Limit (URL). Among admitted patients with an elevated troponin level, ICD-10 diagnoses were categorized, biomarker elevations were recorded, and independent predictors of death in patients with COVID-19 were determined at a median of 6-months following admission.

Of 998 patients, 399 (40 %) had a negative troponin and were not included in the analysis. Additional patients with an elevated troponin were also excluded, either because they were not admitted (n = 68) or had a final diagnosis of Type 1 MI (n = 117). Of the remaining 414 patients with an elevated peak troponin, COVID-19 was the primary diagnosis in 43 patients (10 %) and was the 4th most common diagnosis of patients admitted with myocardial injury behind congestive heart failure, sepsis, and COPD or pneumonia. At a median of 6-months following admission, 18 (42 %) of the COVID-19 patients had died and independent predictors of death (Odd Ratio: Confidence Intervals) were age (1.18: 1.06‒1.37), Troponin level (Log 10 transformed) (16.54: 2.30‒266.65) and C-Reactive Protein (CRP) (1.30: 1.10‒1.65).

Newly diagnosed COVID-19 during the pandemic was a common cause of elevated troponin in hospitalized patients without a Type 1 MI. Age, peak troponin level and peak CRP level were independent predictors of poor outcomes and suggest a need to target these cardiac biomarkers, potentially with novel antioxidant or anti-inflammatory therapies.