Myocardial Biomarkers and COVID-19

 Respiratory infections are a known risk factor for myocardial infarction (MI), and a self-controlled case series study by Kwong and colleagues sought to quantify this risk. Researchers used a public insurance database in Canada to assess their study question, and their results were published in the January 25, 2018 issue of the New England Journal of Medicine.

There were 364 cases of acute myocardial infarction (AMI) in the one year before and after a positive test for influenza. Rates of AMI during the risk interval 7 days after respiratory specimen collection and the nearly 2-year control interval were 20 and 3.3 admissions/wk, respectively. This resulted in an incident ratio for MI in comparing the two periods of 6.05 (95% CI: 3.86, 9.5). The risk for MI did not increase significantly past 7 days after viral testing.

Influenza A and B were associated with the highest risks for AMI, with rates 5- to 10-fold higher in the risk interval; however, infection with respiratory syncytial virus and any other virus were still associated with a higher risk for MI compared with the control period.

Coronavirus disease 2019 (COVID-19) has also been associated with myocardial damage and thrombosis. The current study quantified incident myocardial damage associated with COVID-19 and how such damage may affect patient survival.

Summary:

• A previous study by Kwong and colleagues found that rates of AMI were substantially higher in the 7 days after a respiratory viral infection. Although infection with influenza was associated with the strongest increase in the risk for MI, infection with any respiratory virus was associated with a higher risk for MI as well.
• The current study by Giustino and colleagues demonstrated that 62.6% of patients admitted for severe COVID-19 had elevated serum troponin levels, and most patients with myocardial injury had abnormal findings on TTE. The combination of myocardial injury and abnormal TTE was associated with a higher risk for in-hospital mortality.
• The healthcare team should remain aware of the risk for cardiac involvement among patients with severe COVID-19 and the combination of abnormal troponin levels and TTE findings suggest a worse prognosis.