Prevalence and Prognostic Value of Myocardial Injury in the Initial Presentation of SARS-CoV-2 Infection among Older Adults

Abstract Myocardial involvement during SARS-CoV-2 infection has been reported in many prior publications. Data about this condition in older adults is scarce especially its role in clinical prognosis. We aim to study the prevalence and the clinical implications of acute myocardial injury (MIN) during SARS-CoV-2 infection, particularly in older patients.MethodsLongitudinal observational study where all consecutive adult patients admitted to a COVID-19 unit between March to April 2020 were included. Those patients aged ≥65 were considered as older patients. MIN was defined as at least 1 high-sensitive troponin (hs-TnT) concentration above the 99th percentile upper reference limit with different sex-cutoff.ResultsAmong the 634 patients admitted during the period of observation 365(58%) had evidence of MIN (hs-TnT>14 pg/mL), and among those 224(61%) were older adults. Individuals with acute MIN were more prone to be older, had more comorbidities, more functional decline at admission, and higher inflammatory parameters. Among older adults, MIN was associated with longer time to recovery compared to those without MIN [13 days(IQR 6-21) vs 9 days(IQR 5-17);p<0.001 repectively. In-hospital mortality was significantly higher in older adults with MIN at admission vs those without MIN [71(31%) vs 11(12%);p<0.001]. In a logistic regression model adjusting by age, sex, severity and Charlson comorbidity index the OR for in-hospital mortality was 2.1 (95% CI:1.02-4.42;p=0.043) among those older adults with MIN at presentation.ConclusionMIN is frequent in individuals with SARS-CoV-2 infection, especially in older adults and in patients with pre-existing comorbidities and with higher inflammatory levels. Older adults with acute myocardial injury had greater time to clinical recovery, more severe presentation of the disease and higher odds of in-hospital mortality.