Habets M A W, Sturkenboom H N, Tio R A, Belfroid E, Hoogervorst-Schilp J, Siebelink H J, Jansen C W, Smits P C
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
Knowledge Institute of Medical Specialists, Dutch Association of Medical Specialists, Utrecht, The Netherlands.
Neth Heart J. 2021 May;29(Suppl 1):5-12. doi: 10.1007/s12471-021-01571-w. Epub 2021 Apr 16.
COVID-19 can cause myocardial injury in a significant proportion of patients admitted to the hospital and seems to be associated with worse prognosis. The aim of this review was to study how often and to what extent COVID-19 causes myocardial injury and whether this is an important contributor to outcome with implications for management.
A literature search was performed in Medline and Embase. Myocardial injury was defined as elevated cardiac troponin (cTn) levels with at least one value > 99th percentile of the upper reference limit. The primary outcome measure was mortality, whereas secondary outcome measures were intensive care unit (ICU) admission and length of hospital stay.
Four studies and one review were included. The presence of myocardial injury varied between 9.6 and 46.3%. Myocardial injury was associated with a higher mortality rate (risk ratio (RR) 5.54, 95% confidence interval (CI) 3.48-8.80) and more ICU admissions (RR 3.78, 95% CI 2.07-6.89). The results regarding length of hospital stay were inconclusive.
Patients with myocardial injury might be classified as high-risk patients, with probably a higher mortality rate and a larger need for ICU admission. cTn levels can be used in risk stratification models and can indicate which patients potentially benefit from early medication administration. We recommend measuring cTn levels in all COVID-19 patients admitted to the hospital or who deteriorate during admission.
新型冠状病毒肺炎（COVID-19）可导致相当一部分住院患者发生心肌损伤，且似乎与更差的预后相关。本综述的目的是研究COVID-19导致心肌损伤的频率和程度，以及这是否是影响结局并对治疗有启示意义的重要因素。
在Medline和Embase中进行文献检索。心肌损伤定义为心肌肌钙蛋白（cTn）水平升高，且至少有一个值高于参考上限的第99百分位数。主要结局指标是死亡率，次要结局指标是重症监护病房（ICU）入院率和住院时间。
纳入了四项研究和一篇综述。心肌损伤的发生率在9.6%至46.3%之间。心肌损伤与较高的死亡率（风险比（RR）5.54，95%置信区间（CI）3.48 - 8.80）和更多的ICU入院率（RR 3.78，95% CI 2.07 - 6.89）相关。关于住院时间的结果尚无定论。
心肌损伤患者可能被归类为高危患者，可能具有更高的死亡率和更大的ICU入院需求。cTn水平可用于风险分层模型，并可指示哪些患者可能从早期药物治疗中获益。我们建议对所有入院的COVID-19患者或住院期间病情恶化的患者测量cTn水平。
