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Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.

ABSTRACT: Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available. In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). Association with in-hospital mortality and related predictors represented the main study outcome; myocardial injury and its predictors were deemed secondary outcomes. A total of 674 COVID-19 patients were enrolled, 112 (16.6%) with an established history of CCS. Myocardial injury occurred in 43.8% patients with CCS vs. 14.4% patients without CCS, as confirmed by high-sensitivity cardiac troponin (hs-cTn) elevation on admission or during hospitalization. The mortality rate in the CCS cohort was nearly three-fold higher. After adjusting for disease severity, myocardial injury resulted significantly associated with in-hospital mortality in the no-CCS group but not in CCS patients. Patients with CCS and COVID-19 showed high mortality rate. Myocardial injury may be a bystander in CCS patients and COVID-19, while in patients without known history of CCS, myocardial injury has a significant role in predicting poor outcomes.

SUBMITTER: Schiavone M

PROVIDER: S-EPMC7601151 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.

Schiavone Marco M Gasperetti Alessio A Mancone Massimo M Kaplan Aaron V AV Gobbi Cecilia C Mascioli Giosuè G Busana Mattia M Saguner Ardan M AM Mitacchione Gianfranco G Giacomelli Andrea A Sardella Gennaro G Viecca Maurizio M Duru Firat F Antinori Spinello S Carugo Stefano S Bartorelli Antonio L AL Tondo Claudio C Galli Massimo M Fedele Francesco F Forleo Giovanni B GB

Journal of clinical medicine 20201012 10

<h4>Background</h4>Although studies assessing cardiovascular comorbidities and myocardial injury in Coronavirus disease 2019 (COVID-19) patients have been published, no reports focused on clinical outcomes of myocardial injury in patients with and without chronic coronary syndromes (CCS) are currently available.<h4>Methods</h4>In this study, consecutive COVID-19 patients admitted to four different institutions were screened for enrolment. Patients were divided into two groups (CCS vs. no-CCS). A ...[more]

PMID: 33053826

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Project description:Background and objectiveCoronary artery bypass grafting (CABG) is an effective treatment for coronary artery disease, high risk of complications, making it particularly important to assess patient prognosis. High-sensitivity cardiac troponin (hs-cTn), as a key biomarker of myocardial injury, plays an important role in evaluating the prognosis of patients after CABG. However, the optimal threshold values for hs-cTn in the current guidelines are all artificially set, lacking a unified standard. This narrative review aims to fill the knowledge gap and provide new directions for future research. This is of significant importance for optimizing the management of patients after CABG, improving prognosis, and for developing more precise and personalized treatment strategies.MethodsWe conducted a structured search on PubMed, Web of Science MEDLINE and Cochrane Library using terms like "High-Sensitivity Cardiac Troponin", "Coronary Artery Bypass Grafting", "Prognosis", "Mortality", and "Postoperative Outcomes" to identify English-language studies from inception to 25 July 2024. This article systematically reviews recent studies on hs-cTn levels and prognostic risk factors after CABG, aiming to comprehensively sort out and analyze existing research findings.Key content and findingsStudies show that the release of hs-cTnT and hs-cTnI is related to postoperative myocardial injury/infarction and short-term mortality, but there is still controversy in the conclusions regarding long-term mortality. In addition, different studies have drawn different conclusions about the application of hs-cTnI in postoperative myocardial infarction, restenosis, and hypoxemia, as well as its association with mortality. However, a common view is that the hs-cTn cutoff values used in current clinical practice are too conservative, which may limit the accuracy of its prognosis assessment.ConclusionsHs-cTn has significant value in the prognosis assessment of patients after CABG, but its clinical decision level often exceeds the critical values specified in the guidelines. In the future, more rigorous prospective multicenter trials need to be conducted in different populations to further determine the optimal diagnostic thresholds for hs-cTn, thereby improving the accuracy of prognosis assessment in patients after CABG.

Dataset Information

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.

Publications

Redefining the Prognostic Value of High-Sensitivity Troponin in COVID-19 Patients: The Importance of Concomitant Coronary Artery Disease.

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