Impact of clinical and subclinical coronary artery disease as assessed by coronary artery calcium in COVID-19.
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Scoccia Alessandra, Gallone Guglielmo, Cereda Alberto, Palmisano Anna, Vignale Davide, Leone Riccardo, Nicoletti Valeria, Gnasso Chiara, Monello Alberto, Khokhar Arif, Sticchi Alessandro, Biagi Andrea, Tacchetti Carlo, Campo Gianluca, Rapezzi Claudio, Ponticelli Francesco, Danzi Gian Battista, Loffi Marco, Pontone Gianluca, Andreini Daniele, Casella Gianni, Iannopollo Gianmarco, Ippolito Davide, Bellani Giacomo, Patelli Gianluigi, Besana Francesca, Costa Claudia, Vignali Luigi, Benatti Giorgio, Iannaccone Mario, Vaudano Paolo Giacomo, Pacielli Alberto, De Carlini Caterina Chiara, Maggiolini Stefano, Bonaffini Pietro Andrea, Senni Michele, Scarnecchia Elisa, Anastasio Fabio, Colombo Antonio, Ferrari Roberto, Esposito Antonio, Giannini Francesco, Toselli Marco
Аннотация
METHODS: SARS-CoV 2 positive patients from the multicenter (16 Italian hospitals), retrospective observational SCORE COVID-19 (calcium score for COVID-19 Risk Evaluation) registry were stratified in three groups: (a) "clinical CAD" (prior revascularization history), (b) "subclinical CAD" (CAC >0), (c) "No CAD" (CAC = 0). Primary endpoint was in-hospital mortality and the secondary endpoint was a composite of myocardial infarction and cerebrovascular accident (MI/CVA).
RESULTS: Amongst 1625 patients (male 67.2%, median age 69 [interquartile range 58-77] years), 31%, 57.8% and 11.1% had no, subclinical and clinical CAD, respectively. Increasing rates of in-hospital mortality (11.3% vs. 27.3% vs. 39.8%, p < 0.001) and MI/CVA events (2.3% vs. 3.8% vs. 11.9%, p < 0.001) were observed for patients with no CAD vs. subclinical CAD vs clinical CAD, respectively. The association with in-hospital mortality was independent of in-study outcome predictors (age, peripheral artery disease, active cancer, hemoglobin, C-reactive protein, LDH, aerated lung volume): subclinical CAD vs. No CAD: adjusted hazard ratio (adj-HR) 2.86 (95% confidence interval [CI] 1.14-7.17, p=0.025); clinical CAD vs. No CAD: adj-HR 3.74 (95% CI 1.21-11.60, p=0.022). Among patients with subclinical CAD, increasing CAC burden was associated with higher rates of in-hospital mortality (20.5% vs. 27.9% vs. 38.7% for patients with CAC score thresholds≤100, 101-400 and > 400, respectively, p < 0.001). The adj-HR per 50 points increase in CAC score 1.007 (95%CI 1.001-1.013, p=0.016). Cardiovascular risk factors were not independent predictors of in-hospital mortality when CAD presence and extent were taken into account.
CONCLUSIONS: The presence and extent of CAD are associated with in-hospital mortality and MI/CVA among hospitalized patients with COVID-19 disease and they appear to be a better prognostic gauge as compared to a clinical cardiovascular risk assessment.