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
ARTICLE HIGHLIGHTS
Research background

Several studies have proposed that troponin elevation seen in coronavirus disease 2019 (COVID-19) patients is due to an interplay between viral myocarditis, demand ischemia and renin-angiotensin-aldosterone system pathway activation. This creates the hypothesis that the use of steroids, antivirals and angiotensin-converting enzyme inhibitors (ACEI) in patients with COVID-19 infection and troponin elevation would impact mortality outcomes.

Research motivation

The COVID-19 pandemic has had a monumental global impact and resulted in several deaths worldwide. The motivation of this study was to analyze if the use of the steroids, antivirals and ACEI would improve survival in patient with COVID-19 infection and troponin elevation.

Research objectives

Our main objective was to analyze any differences in mortality in our subjects, in the hopes of adding to existing knowledge and creating a standardized treatment protocol in patients with COVID-19 and troponin elevation.

Research methods

Our study design was a retrospective observational study consisting of 1788 COVID-19 patients at seven hospitals across Southern California. To determine the predictors of mortality in our subjects, we did a backward selection cox multivariate regression analysis. Furthermore, to analyze survival in the subset of patients with troponin elevation we did a Kaplan Meier analysis comparing those that received treatment with steroids, remdesivir and ACEI and those that did not.

Research results

Though the beneficial role of steroids in the treatment of COVID-19 has been established, our study did not show any statistically significant difference in mortality in patients with elevated troponin who received steroids and those that did not. Therefore, the role of steroids in myocarditis caused by COVID-19 is still unclear and needs further investigation. On the other hand, our study showed improved survival in COVID-19 patients with elevated troponin that received remdesivir, although this was not statistically significant.

Research conclusions

Although the mechanism of troponin elevation in COVID-19 patient has been linked to viral myocarditis and renin-angiotensin-aldosterone system activation, the novel treatments of these subsequent pathologies including steroids, remdesivir and ACEI showed no significant survival benefit in our study. This creates the theory that there are other mechanisms at play guiding this complex interaction.

Research perspectives

Although our study did not show a statistically significant mortality benefit with the use of steroids and remdesivir, our sub-group analysis was limited by a small sample size, so further studies on the effect of remdesivir in the sub-set of COVID-19 patients with elevated troponin using a larger population will be beneficial.