Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection

J Am Coll Cardiol. 2020 Aug 4;76(5):533-546. doi: 10.1016/j.jacc.2020.06.007. Epub 2020 Jun 8.


Background: The degree of myocardial injury, as reflected by troponin elevation, and associated outcomes among U.S. hospitalized patients with coronavirus disease-2019 (COVID-19) are unknown.

Objectives: The purpose of this study was to describe the degree of myocardial injury and associated outcomes in a large hospitalized cohort with laboratory-confirmed COVID-19.

Methods: Patients with COVID-19 admitted to 1 of 5 Mount Sinai Health System hospitals in New York City between February 27, 2020, and April 12, 2020, with troponin-I (normal value <0.03 ng/ml) measured within 24 h of admission were included (n = 2,736). Demographics, medical histories, admission laboratory results, and outcomes were captured from the hospitals' electronic health records.

Results: The median age was 66.4 years, with 59.6% men. Cardiovascular disease (CVD), including coronary artery disease, atrial fibrillation, and heart failure, was more prevalent in patients with higher troponin concentrations, as were hypertension and diabetes. A total of 506 (18.5%) patients died during hospitalization. In all, 985 (36%) patients had elevated troponin concentrations. After adjusting for disease severity and relevant clinical factors, even small amounts of myocardial injury (e.g., troponin I >0.03 to 0.09 ng/ml; n = 455; 16.6%) were significantly associated with death (adjusted hazard ratio: 1.75; 95% CI: 1.37 to 2.24; p < 0.001) while greater amounts (e.g., troponin I >0.09 ng/dl; n = 530; 19.4%) were significantly associated with higher risk (adjusted HR: 3.03; 95% CI: 2.42 to 3.80; p < 0.001).

Conclusions: Myocardial injury is prevalent among patients hospitalized with COVID-19; however, troponin concentrations were generally present at low levels. Patients with CVD are more likely to have myocardial injury than patients without CVD. Troponin elevation among patients hospitalized with COVID-19 is associated with higher risk of mortality.

Keywords: COVID-19; coronavirus; myocardial injury; troponin.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / epidemiology
  • Comorbidity*
  • Coronavirus Infections / complications*
  • Coronavirus Infections / epidemiology
  • Electronic Health Records
  • Female
  • Heart Injuries / complications
  • Heart Injuries / epidemiology
  • Hospitalization
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / epidemiology
  • Myocardium / pathology*
  • New York City
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / epidemiology
  • Prevalence
  • Risk Factors
  • Treatment Outcome
  • Troponin I / blood*
  • Young Adult


  • Troponin I

Supplementary concepts

  • COVID-19