Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation  

作　　者：Chukwuemeka A Umeh Heather Maoz Jessica Obi Ruchi Dakoria Smit Patel Gargi Maity Pranav Barve 

机构地区：[1]Internal Medicine,Hemet Global Medical Center,Hemet,CA 92543,United States

出　　处：《World Journal of Cardiology》2023年第9期427-438,共12页世界心脏病学杂志（英文版）（电子版）

摘　　要：BACKGROUND There are indications that viral myocarditis,demand ischemia,and renin-angio-tensin-aldosterone system pathway activation play essential roles in troponin elevation in coronavirus disease 2019(COVID-19)patients.Antiviral medications and steroids are used to treat viral myocarditis,but their effect in patients with elevated troponin,possibly from myocarditis,has not been studied.AIM To evaluate the effect of dexamethasone,remdesivir,and angiotensin-converting enzyme(ACE)inhibitors(ACEI)on mortality in COVID-19 patients with elevated troponin.METHODS Our retrospective observational study involved 1788 COVID-19 patients at seven hospitals in Southern California,United States.We did a backward selection Cox multivariate regression analysis to determine predictors of mortality in our study population.Additionally,we did a Kaplan Meier survival analysis in the subset of patients with elevated troponin,comparing survival in patients that received dexamethasone,remdesivir,and ACEI with those that did not.RESULTS The mean age was 66 years(range 20-110),troponin elevation was noted in 11.5%of the patients,and 29.9%expired.The patients'age[hazard ratio(HR)=1.02,P<0.001],intensive care unit admission(HR=5.07,P<0.001),and ventilator use(HR=0.68,P=0.02)were significantly associated with mortality.In the subset of patients with elevated troponin,there was no statistically significant difference in survival in those that received remdesivir(0.07),dexamethasone(P=0.63),or ACEI(P=0.8)and those that did not.CONCLUSION Although elevated troponin in COVID-19 patients has been associated with viral myocarditis and ACE II receptors,conventional viral myocarditis treatment,including antiviral and steroids,and ACEI did not show any effect on mortality in these patients.

关 键 词：Coronavirus disease 2019 Troponin elevation Remdesevir Ace inhibitor STEROIDS 

分 类 号：R541.75[医药卫生—心血管疾病]