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Evolution of Management and Outcomes of Patients with Myocardial Injury During the COVID-19 Pandemic.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2021 Oct 15; Vol. 157, pp. 42-47. Date of Electronic Publication: 2021 Jul 24. - Publication Year :
- 2021
-
Abstract
- Cardiac involvement in coronavirus disease 2019 (COVID-19) has been established. This is manifested by troponin elevation and associated with worse patient prognosis. We evaluated whether patient outcomes improved as experience accumulated during the pandemic. We analyzed COVID-19-positive patients with myocardial injury (defined as troponin elevation) who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the "Early Phase" of the pandemic (March 1 - June 30, 2020) and compared their characteristics and outcomes to the COVID-19-positive patients with the presence of troponin elevation in the "Later Phase" of the pandemic (October 1, 2020 - January 31, 2021). The cohort included 788 COVID-19-positive admitted patients for whom troponin was elevated, 167 during the "Early Phase" and 621 during the "Later Phase." Maximum troponin-I in the "Early Phase" was 13.46±34.72 ng/mL versus 11.21±20.57 ng/mL in the "Later Phase" (p = 0.553). In-hospital mortality was significantly higher in the "Later Phase" (50.3% vs. 24.6%; p<0.001), as were incidence of intensive-care-unit admission (77.8% vs. 46.1%; p<0.001) and need for mechanical ventilation (61.7% versus 28%; p<0.001). In addition, more "Early Phase" patients underwent coronary angiography (6% vs. 2.3%; p=0.013). Finally, 3% of "Early Phase" and 0.8% of "Later Phase" patients underwent percutaneous coronary intervention (p=0.025). In conclusion, treatment outcomes have significantly improved since the beginning of the pandemic in COVID-19-positive patients with troponin elevation. This may be attributed to awareness, severity of the disease, improvements in therapies, and provider experience.<br /> (Copyright © 2021. Published by Elsevier Inc.)
- Subjects :
- Aged
Aged, 80 and over
Clinical Competence
Cohort Studies
Coronary Angiography statistics & numerical data
District of Columbia epidemiology
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Maryland epidemiology
Middle Aged
Myocardial Infarction epidemiology
Pandemics
Patient Admission statistics & numerical data
Percutaneous Coronary Intervention statistics & numerical data
Respiration, Artificial statistics & numerical data
COVID-19 epidemiology
Myocardial Infarction therapy
Troponin I blood
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 157
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 34384590
- Full Text :
- https://doi.org/10.1016/j.amjcard.2021.07.022