From the very beginning, reports emerged about the numerous cardiac complications associated with COVID-19.  In the largest study to date performed on this topic in China, researchers examined the prognostic value of myocardial injury on patient outcomes. There are many valuable lessons learned from this paper, but the most immediately relevant are:

  • Elevated troponins carry an extremely poor prognosis. The mortality in patients with elevated troponins was 60% compared to only 9% for those with normal troponins
  • Myocardial injury is a LATE complication of COVID-19. The median length between onset of first symptoms and death was 23 days
  • While underlying CAD is associated with worse outcomes than no CAD that association is weaker than elevated Troponins. Consider the mortality data for the following four groups:
    • Underlying CAD + elevated Troponin:              70%
    • No CAD + elevated Troponins:                          38%
    • Underlying CAD + normal Troponin:                 13%
    • No CAD + normal Troponin:                               7%


Patients with elevated Troponins also had higher rates of malignant arrhythmias. While NT-proBNP levels were elevated as well, they were not specifically connected to any adverse outcomes and their prognostic value remains uncertain.

The high rates of cardiovascular involvement in COVID-19 has prompted many to consider the use of statins. While there are no studies on the subject, the enthusiasm for statin therapy is grounded in the following facts:

  • Statins are extremely safe
  • Statin decrease mortality in many cardiovascular diseases
  • Myocardial injury is common in COVID-19
  • Statins decrease inflammation which is the hypothesized mechanism of myocardial injury in COVID-19

Guidelines for statin therapy and cardiovascular testing would probably continue to evolve. The approach I currently favor is:

  • Continue statins in any patients who is already on statins
  • Consider starting statins if the patient has cardiovascular risk factors (10-years ASCVD risk being the most commonly used calculator)
  • Strongly consider starting statins is there is any evidence of myocardial injury regardless of risk factors
  • Check Troponin and NT-proBNP on all COVID-19 patients on admission and every other day while hospitalized

BOTTOM LINE: Elevated troponins carry a very poor prognosis. Initiate statin therapy and closely monitor for late cardiac manifestations of COVID-19.