Myocardial Injury and Major Adverse Outcomes in Patients With COVID-19

The study team's understanding of diagnosis, treatment and outcomes of coronavirus disease
2019 (COVID-19) is rapidly evolving. First reports from China clearly indicate that older
patients with underlying cardiovascular disease and/or cardiac risk factors demonstrate
higher mortality rates. Most recent reports provided novel insights into the incidence of
myocardial injury in COVID-19 patients and its association with adverse outcomes. In both
studies, patients with myocardial injury manifested by elevated high-sensitivity troponin I
(TnI) levels had significantly higher in-hospital mortality rates compared with those without
myocardial injury, (59.6 and 8.9% (3) and 51 vs 4.5 %). Among patients with myocardial
injury, higher levels of TnI were associated with higher mortality rates. While the highest
mortality rates were observed in patients with elevated TnI and underlying cardiovascular
disease (CVD), mortality rates were also considerable in patients with elevated TnI and
without prior CVD. In contrast, patients with known cardiovascular disease without TnI
elevation had more favorable outcomes. Cardiac injury was independently associated with an
increased risk of mortality in patients with COVID-19. The arming reports clearly indicate
that the data from larger populations from multiple centers are needed to further
characterize and better understand the association between myocardial injury and adverse
outcomes in COVID-19 patients.

II. STUDY AIM The aim of the proposed study is to analyze the incidence, clinical outcomes
and predictors of myocardial injury in a large patient population with COVID-19 treated in
Mount Sinai Hospital (MSH) system. In addition, the study team will explore the association
between TnI levels and clinical characteristics, biomarkers, cardiac tests data and treatment
approaches to uncover the potential mechanisms responsible for COVID-19 induced myocardial
injury.

III. STUDY POPULATION By October 2020, there have been 4,695 COVID-19 positive patients
treated in the Mount Sinai Hospital (MSH) and more than 1,1000 patients with COVID-19 had
been healed and discharged. All consecutive patients admitted to the MSH system from February
2020 to October 2020 with laboratory-confirmed COVID-19 will be included in the retrospective
study.