Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2023; 15(9): 427-438
Published online Sep 26, 2023. doi: 10.4330/wjc.v15.i9.427
Remdesivir, dexamethasone and angiotensin-converting enzyme inhibitors use and mortality outcomes in COVID-19 patients with concomitant troponin elevation
Chukwuemeka A Umeh, Heather Maoz, Jessica Obi, Ruchi Dakoria, Smit Patel, Gargi Maity, Pranav Barve
Chukwuemeka A Umeh, Heather Maoz, Jessica Obi, Ruchi Dakoria, Smit Patel, Gargi Maity, Pranav Barve, Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
Author contributions: Umeh CA, Maoz H, Obi J, Dakoria R, Patel S, Maity G and Barve P conceptualized and revised the study design; Umeh CA analyzed the data; Maoz H, Umeh CA, Obi J, Dakoria R, Patel S, and Maity G, wrote the first draft of the paper; Barve P and Umeh CA, reviewed and revised the paper; Maoz H led and coordinated the research and writing of the manuscript; Barve P and Umeh CA supervised the project; all authors have read and approved the final manuscript.
Institutional review board statement: The WIRB-Copernicus Group (WCG) institutional review board (IRB) approved the study. IRB approval number: 13410516.
Informed consent statement: Our study was a retrospective observational study which used medical records for data acquisition and analysis and thus does not require informed consent from subjects.
Conflict-of-interest statement: None to declare.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Heather Maoz, MD, Doctor, Internal Medicine, Hemet Global Medical Center, 1117 E. Devonshire Ave., Hemet, CA 92543, United States. heathermaoz@gmail.com
Received: April 21, 2023
Peer-review started: April 21, 2023
First decision: June 19, 2023
Revised: July 12, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: September 26, 2023
Processing time: 152 Days and 16.4 Hours
Abstract
BACKGROUND

There are indications that viral myocarditis, demand ischemia, and renin-angiotensin-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.

Keywords: Coronavirus disease 2019; Troponin elevation; Remdesevir; Ace inhibitor; Steroids

Core Tip: Myocarditis from direct viral injury or related to angiotensin-converting enzyme (ACE) II downregulation with subsequent hyperactivity of the renin-angiotensin-aldosterone system plays an essential role in troponin elevation in coronavirus disease 2019 (COVID-19) patients. However, the effect of antiviral medications and steroids used to treat viral myocarditis has not been well-studied in patients with elevated troponins, which this study sought to address. We found no significant difference in survival rates in COVID-19 patients with elevated troponin that received remdesivir, dexamethasone, or ACE inhibitors vs those that did not. The implication for practice is that treatment with various medications that could be beneficial in viral myocarditis did not show any mortality benefit in our study for COVID-19 patients with troponin elevation.