The prognostic value of serial troponin measurements in patients admitted for COVID-19

38noAims: Myocardial injury (MI) in coronavirus disease-19 (COVID-19) is quite prevalent at admission and affects prognosis. Little is known about troponin trajectories and their prognostic role. We aimed to describe the early in-hospital evolution of MI and its prognostic impact. Methods and results: We performed an analysis from an Italian multicentre study enrolling COVID-19 patients, hospitalized from 1 March to 9 April 2020. MI was defined as increased troponin level. The first troponin was tested within 24 h from admission, the second one between 24 and 48 h. Elevated troponin was defined as values above the 99th percentile of normal values. Patients were divided in four groups: normal, normal then elevated, elevated then normal, and elevated. The outcome was in-hospital death. The study population included 197 patients; 41% had normal troponin at both evaluations, 44% had elevated troponin at both assessments, 8% had normal then elevated troponin, and 7% had elevated then normal troponin. During hospitalization, 49 (25%) patients died. Patients with incident MI, with persistent MI, and with MI only at admission had a higher risk of death compared with those with normal troponin at both evaluations (P < 0.001). At multivariable analysis, patients with normal troponin at admission and MI injury on Day 2 had the highest mortality risk (hazard ratio 3.78, 95% confidence interval 1.10–13.09, P = 0.035). Conclusions: In patients admitted for COVID-19, re-test MI on Day 2 provides a prognostic value. A non-negligible proportion of patients with incident MI on Day 2 is identified at high risk of death only by the second measurement.openopenNuzzi V.; Merlo M.; Specchia C.; Lombardi C.M.; Carubelli V.; Iorio A.; Inciardi R.M.; Bellasi A.; Canale C.; Camporotondo R.; Catagnano F.; Dalla Vecchia L.A.; Giovinazzo S.; Maccagni G.; Mapelli M.; Margonato D.; Monzo L.; Oriecuia C.; Peveri G.; Pozzi A.; Provenzale G.; Sarullo F.; Tomasoni D.; Ameri P.; Gnecchi M.; Leonardi S.; Agostoni P.; Carugo S.; Danzi G.B.; Guazzi M.; La Rovere M.T.; Mortara A.; Piepoli M.; Porto I.; Volterrani M.; Senni M.; Metra M.; Sinagra G.Nuzzi, V.; Merlo, M.; Specchia, C.; Lombardi, C. M.; Carubelli, V.; Iorio, A.; Inciardi, R. M.; Bellasi, A.; Canale, C.; Camporotondo, R.; Catagnano, F.; Dalla Vecchia, L. A.; Giovinazzo, S.; Maccagni, G.; Mapelli, M.; Margonato, D.; Monzo, L.; Oriecuia, C.; Peveri, G.; Pozzi, A.; Provenzale, G.; Sarullo, F.; Tomasoni, D.; Ameri, P.; Gnecchi, M.; Leonardi, S.; Agostoni, P.; Carugo, S.; Danzi, G. B.; Guazzi, M.; La Rovere, M. T.; Mortara, A.; Piepoli, M.; Porto, I.; Volterrani, M.; Senni, M.; Metra, M.; Sinagra, G