key: cord-0971230-cbia28yr
authors: Kuno, Toshiki; Takahashi, Mai; Obata, Reiichiro; Maeda, Tetsuro
title: Cardiovascular comorbidities, cardiac injury and prognosis of COVID-19 in New York City
date: 2020-05-15
journal: Am Heart J
DOI: 10.1016/j.ahj.2020.05.005
sha: 27d2e026cee89137b59cc4822f1e461b86e4c090
doc_id: 971230
cord_uid: cbia28yr

Abstract Using Mt. Sinai (New York City) EMR health system data, we retrospectively analyzed a cohort of 8438 COVID-19 patients seen between March 1st and April 22nd 2020. Risk of intubation and of death rose as a function of increasing age and as a function of greater cardiovascular comorbidity. Combining age and specific comorbidity markers showed patterns suggesting that cardiovascular comorbidities increased relative risks for adverse outcomes most substantially in the younger subjects with progressively diminishing relative effects at older ages.

J o u r n a l P r e -p r o o f Abstract Using Mt Sinai (New York City) EMR health system data, we retrospectively analyzed a cohort of 8,438 COVID-19 patients seen between March 1 st and April 22 nd 2020. Risk of intubation and of death rose as a function of increasing age and as a function of greater cardiovascular comorbidity. Combining age and specific comorbidity markers showed patterns suggesting that cardiovascular comorbidities increased relative risks for adverse outcomes most substantially in the younger subjects with progressively diminishing relative effects at older ages.

Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, has spread all around the world since December 2019 (1). As of April 22 nd , its epicenter is New York (2) . Previous studies demonstrated that cardiac injury or comorbidities increased the risk of in-hospital mortality in patients with COVID-19 (3, 4) . The aim of this study is to investigate whether cardiovascular disease or cardiac injury increased the risk of mechanical ventilation or mortality using the electronic medical records (EMR) of Mount Sinai Health System in New York City (5) .

We analyzed the EMR of COVID19 positive patients from Mount Sinai Health System which used EPIC electronic health record system from March 1st to April 22 nd , 2020. Mount Sinai health system combines 7 hospitals with more than 3,800 beds and more that 410 ambulatory practices across metropolitan New York. Among 8,438 J o u r n a l P r e -p r o o f patients, 54.7% of patients (N=4,616) were admitted to these hospitals. Analysis was performed on April 30 th , 2020, which included patients who remained in the hospitals.

Age, history of coronary artery disease (CAD), peripheral artery disease (PAD), heart failure, and cardiac injury as well as necessity of mechanical ventilation and mortality among patients with positive polymerase chain reaction test of COVID-19 were extracted. Cardiac injury was defined as troponin I elevation which was defined as 99th percentile upper reference limit. Patients with cardiac injury were compared with those without troponin I elevation among a total of 5,320 patients' measurements (63.0%) (6).

Mount Sinai Health System waived institutional review board approval since this research used only deidentified, aggregate-level data (5) . No extramural funding was used to support this work and the authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.

Among 8,438 patients with COVID-19, 8.6% of patients had CAD, 8.1% of patients had PAD, 6.9% of patients had heart failure. Table 1 shows baseline characteristics of this cohort. 43.5% of patients had troponin I elevation among patients who had troponin I measurements. Table 2 shows the crude rates of mechanical ventilation and mortality.

Patients with a history of CAD, PAD, or heart failure had significantly higher rates of mechanical ventilation and mortality. Notably, cardiac injury demonstrated significantly higher relative risk (RR) of mechanical ventilation (3.45 [95% confidence interval 2.87-4.14]) and of mortality (5.07 [4.45-5 .76]) ( Table 2) . We detected higher rates of mechanical ventilation and mortality in patients with history of CAD, PAD and heart Journal Pre-proof J o u r n a l P r e -p r o o f failure in all age groups except > 80 years, with relatively higher RR in younger population ( Table 2 ).

Our study revealed increased risk of mechanical ventilation and mortality in patients with cardiovascular comorbidities or cardiac injury. Since we present crude event rates, further study is needed to confirm our findings. J o u r n a l P r e -p r o o f 

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Universal Definition of Myocardial Infarction

CAD: coronary artery disease, CI: Confidential interval, HF: heart failure, PAD: peripheral artery disease