tetano
Editor, Senior Moderator
Arch Cardiovasc Dis
. 2022 Mar 4;S1875-2136(22)00043-2.
doi: 10.1016/j.acvd.2022.02.007. Online ahead of print.
Coronary artery calcifications and 6-month mortality in patients with COVID-19 without known atheromatous disease
Anne-Sophie Le Hir[SUP] 1 [/SUP], Antoine Fayol[SUP] 2 [/SUP], Elie Mousseaux[SUP] 3 [/SUP], Nicolas Danchin[SUP] 4 [/SUP], Victoria Tea[SUP] 5 [/SUP], Chekrallah Chamandi[SUP] 5 [/SUP], Gilles Soulat[SUP] 3 [/SUP], Etienne Puymirat[SUP] 6 [/SUP]
Affiliations
Abstract
Background: Coronary artery calcium (CAC) is an independent risk factor for major adverse cardiovascular events; however, its impact on coronavirus disease 2019 (COVID-19) mortality remains unclear, especially in patients without known atheromatous disease.
Aims: To evaluate the association between CAC visual score and 6-month mortality in patients without history of atheromatous disease hospitalized with COVID-19 pneumonia.
Methods: A single-centre observational cohort study was conducted, involving 293 consecutive patients with COVID-19 in Paris, France, between 13 March and 30 April 2020, with a 6-month follow-up. Patients with a history of ischaemic stroke or coronary or peripheral artery disease were excluded. The primary outcome was all-cause mortality at 6 months according to CAC score, which was assessed by analysing images obtained after the first routine non-electrocardiogram-gated computed tomography scan performed to detect COVID-19 pneumonia.
Results: A total of 251 patients (mean age 64.8±16.7 years) were included in the analysis. Fifty-one patients (20.3%) died within 6 months. The mortality rate increased with the magnitude of calcifications, and was 10/101 (9.9%), 15/66 (22.7%), 10/34 (29.4%) and 16/50 (32.0%) for the no CAC, mild CAC, moderate CAC and heavy CAC groups, respectively (p=0.004). Compared with the no calcification group, adjusted risk of death increased progressively with CAC: hazard ratio (HR) 2.37 (95% confidence interval [CI] 1.06-5.27), HR 3.1 (95% CI 1.29-7.45) and HR 4.02 (95% CI 1.82-8.88) in the mild, moderate and heavy CAC groups, respectively.
Conclusions: Non-electrocardiogram-gated computed tomography during the initial pulmonary assessment of patients with COVID-19 without atherosclerotic cardiovascular disease showed a high prevalence of mild, moderate and heavy CAC. CAC score was related to 6-month mortality, independent of conventional cardiovascular risk factors. These results highlight the importance of CAC scoring for patients hospitalized with COVID-19, and calls for attention to patients with high CAC.
Keywords: COVID-19; Coronaropathie; Coronary artery disease; Lésion myocardique; Mortality; Mortalité; Myocardial injury; Risk stratification; Stratification du risque.
. 2022 Mar 4;S1875-2136(22)00043-2.
doi: 10.1016/j.acvd.2022.02.007. Online ahead of print.
Coronary artery calcifications and 6-month mortality in patients with COVID-19 without known atheromatous disease
Anne-Sophie Le Hir[SUP] 1 [/SUP], Antoine Fayol[SUP] 2 [/SUP], Elie Mousseaux[SUP] 3 [/SUP], Nicolas Danchin[SUP] 4 [/SUP], Victoria Tea[SUP] 5 [/SUP], Chekrallah Chamandi[SUP] 5 [/SUP], Gilles Soulat[SUP] 3 [/SUP], Etienne Puymirat[SUP] 6 [/SUP]
Affiliations
- PMID: 35305915
- DOI: 10.1016/j.acvd.2022.02.007
Abstract
Background: Coronary artery calcium (CAC) is an independent risk factor for major adverse cardiovascular events; however, its impact on coronavirus disease 2019 (COVID-19) mortality remains unclear, especially in patients without known atheromatous disease.
Aims: To evaluate the association between CAC visual score and 6-month mortality in patients without history of atheromatous disease hospitalized with COVID-19 pneumonia.
Methods: A single-centre observational cohort study was conducted, involving 293 consecutive patients with COVID-19 in Paris, France, between 13 March and 30 April 2020, with a 6-month follow-up. Patients with a history of ischaemic stroke or coronary or peripheral artery disease were excluded. The primary outcome was all-cause mortality at 6 months according to CAC score, which was assessed by analysing images obtained after the first routine non-electrocardiogram-gated computed tomography scan performed to detect COVID-19 pneumonia.
Results: A total of 251 patients (mean age 64.8±16.7 years) were included in the analysis. Fifty-one patients (20.3%) died within 6 months. The mortality rate increased with the magnitude of calcifications, and was 10/101 (9.9%), 15/66 (22.7%), 10/34 (29.4%) and 16/50 (32.0%) for the no CAC, mild CAC, moderate CAC and heavy CAC groups, respectively (p=0.004). Compared with the no calcification group, adjusted risk of death increased progressively with CAC: hazard ratio (HR) 2.37 (95% confidence interval [CI] 1.06-5.27), HR 3.1 (95% CI 1.29-7.45) and HR 4.02 (95% CI 1.82-8.88) in the mild, moderate and heavy CAC groups, respectively.
Conclusions: Non-electrocardiogram-gated computed tomography during the initial pulmonary assessment of patients with COVID-19 without atherosclerotic cardiovascular disease showed a high prevalence of mild, moderate and heavy CAC. CAC score was related to 6-month mortality, independent of conventional cardiovascular risk factors. These results highlight the importance of CAC scoring for patients hospitalized with COVID-19, and calls for attention to patients with high CAC.
Keywords: COVID-19; Coronaropathie; Coronary artery disease; Lésion myocardique; Mortality; Mortalité; Myocardial injury; Risk stratification; Stratification du risque.