Association between coronary artery calcifications and 6-month mortality in hospitalized patients with COVID-19 - 24/07/21
, Antoine Fayol a, c, d, Nicolas Danchin a, e, Gilles Soulat a, b, c, Etienne Charpentier a, b, Marine Livrozet a, d, Jean-Baptiste Carves a, d, Victoria Tea a, c, Fares Ben Salem a, b, Chekrallah Chamandi a, c, Jean-Sébastien Hulot a, c, d, Etienne Puymirat a, c, e
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Highlights |
• | Little is known about the impact of atherosclerotic plaque burden on fatal outcomes in patients with COVID-19. |
• | In 169 patients with COVID-19, based on non-ECG-gated chest CT at admission, 37% with either moderate or heavy coronary artery calcification had higher 6-month mortality independently of age, cardiovascular risk factors, lung damage extent and high sensitivity cardiac troponin I level at admission. |
• | COVID-19 patients with moderate and heavy coronary CAC have higher 6-month mortality risk. These patients can be detected with non-gated CT at admission and should benefit of more aggressive management. |
Abstract |
Purpose |
The purpose of this study was to evaluate the association between coronary artery calcium (CAC) visual score and 6-month mortality in patients with coronavirus disease 2019 (COVID-19).
Material and methods |
A single-center prospective observational cohort was conducted in 169 COVID-19 consecutive hospitalized patients between March 13 and April 1, 2020, and follow-up for 6-months. A four-level visual CAC scoring was assessed by analyzing images obtained after the first routine non-ECG-gated CT performed to detect COVID-19 pneumonia.
Results |
Among 169 confirmed COVID-19 patients (118 men, 51 women; mean age, 65.6 ± 18.8 [SD] years; age range: 30–95 years) 63 (37%) presented with either moderate (n = 26, 15.3%) or heavy (n = 37, 21.8%) CAC detected by CT and 20 (11.8%) had history of cardiovascular disease requiring specific preventive treatment. At six months, mortality rate (45/169; 26.6%) increased with magnitude of CAC and was 7/64 (10.9%), 11/42 (26.2%), 10/26 (38.5%), 17/37 (45.9%) for no-CAC, mild-CAC, moderate-CAC and heavy-CAC groups, respectively (P = 0.001). Compared to the no CAC group, risk of death increased after adjustment with magnitude of CAC (HR: 2.23, 95% CI: 0.73–6.87, P = 0.16; HR: 2.78, 95% CI: 0.85–9.07, P0.09; HR: 5.38, 95% CI: 1.57–18.40, P = 0.007; in mild CAC, moderate and heavy CAC groups, respectively). In patients without previous coronary artery disease (154/169; 91%), mortality increased from 10.9% to 45.8% (P = 0.001) according to the magnitude of CAC categories. After adjustment, presence of moderate or heavy CAC was associated with higher mortality (HR: 2.26, 95% CI: 1.09–4.69, P = 0.03).
Conclusion |
By using non-ECG-gated CT during the initial pulmonary assessment of COVID-19, heavy CAC is independently associated with 6-month mortality in patients hospitalized for severe COVID-19 pneumonia.
El texto completo de este artículo está disponible en PDF.Keywords : COVID-19, Outcomes, Computed tomography, Myocardial injury, Coronary artery calcification
Mots-clés : Abbreviations: ASCVD, BNP, CI, CT, CAC, CHD, COVID-19, ECG, HR, HS-troponin I, HU, IQR, kVp, SD
Esquema
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.