Ghufran1, Osman Faheem1, Nasir Rahman1, Maria Ali Khan1, Ihsanullah Dawlat1, Arsalan Ahmed1, Jamshed Ali1

1Aga Khan University Hospital

Myocardial injury has been reported in COVID 19 patients frequently and is associated with poor outcomes. The study aimed to determine the impact of a myocardial injury on outcomes in COVID-19 in low to middle-income countries.

We prospectively collected data of patients admitted with a diagnosis of COVID 19 from 26 February to 15 August 2020 at tertiary care center Aga Khan University Hospital, Karachi. We analyzed data using the Cox proportional hazard model to assess the impact of myocardial injury in COVID 19 patients.

Of 704 patients admitted with COVID 19, 138(19%) patients had the myocardial injury. The mean age of patients was 64 ±14, with 73%(n=101) male. Diabetes (56%) was the most common comorbidity, followed by hypertension (28%). Our analysis shows that the patients on beta-blockers (39%) and ACEi/ ARBS (26%) were not significantly associated with poor outcomes. The median Trop I value was 0.44. The medication used was steroids (75%), azithromycin (38%), tocilizumab (26%), HCQ (16%), and plasmapheresis (14%). The complications observed were ARDs (47%), AKI (44%), arrhythmia (12%), coagulopathy (7%), acute liver failure (6%), and VT/Vfib (3%). The length of hospital stay was more than a week in 53%(n=73) of patients; 30%(n=41) require mechanical ventilation, and the incidence of mortality was 37%(n=52). The multivariable analysis shows that TropI value, deranged INR, ARDS, treatment with azithromycin were associated with poor outcomes in patients with myocardial injury due to COVID 19. However, the use of HCQ and normal platelet count was associated with improving prognosis.

Myocardial injury in COVID 19 is associated with increased mortality, length of hospital stays, and mechanical ventilation use. Azithromycin should be used with caution in patients with myocardial injury.