Impact of clinical and subclinical coronary artery disease as assessed by coronary artery calcium in COVID-19

Abstract

Background and aims The potential impact of coronary atherosclerosis, as detected by coronary artery calcium, on clinical outcomes in COVID-19 patients remains unsettled. We aimed to evaluate the prognostic impact of clinical and subclinical coronary artery disease (CAD), as assessed by coronary artery calcium score (CAC), in a large, unselected population of hospitalized COVID-19 patients undergoing non-gated chest computed tomography (CT) for clinical practice. Methods SARS-CoV 2 positive patients from the multicenter (16 Italian hospitals), retrospective observational SCORE COVID-19 (calcium s core for CO VID-19 R isk E valuation) 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 ri...

Teaching an old dog new tricks: The prognostic role of CACS in hospitalized COVID-19 patients

“…The data presented by Scoccia et al [1] further add to prior literature in expanding a novel use of CACS by showing a link with COVID-19 outcomes. On a pathophysiologic basis, such a link is plausible as CACS is a marker of the cumulative vascular damage brought by prolonged exposure to risk factors.…”

“…In this issue of Atherosclerosis, Scoccia et al present an interesting study on the prognostic role of coronary artery calcium scores (CACS) in COVID-19 [1]. They used a large unselected population of patients hospitalized in 16 Italian hospitals for severe COVID-19.…”

The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification

“…The analysis of cardiovascular calcifications allows to "photograph" the cardiovascular burden of every single patient at a precise moment. In contrast, cardiovascular anamnestic variables are often retrospective and may underestimate the cardiovascular burden, especially in women [7,15]. The present study's limitations are the retrospective analysis of the clinical and radiological data collected during the first pandemic wave peak.…”

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

“…Third, obesity is associated with vascular dysfunction, particularly altered endothelial function and accelerated atherosclerosis [81]. These changes predispose patients to the development of cardiovascular disease, which in turn has an adverse impact on COVID-19 mortality [13,82]. Obesity may also cause respiratory difficulties, and may lead to practical problems when maintaining patients on assisted ventilation with higher degrees of obesity; however, evidence regarding the importance of this factor has been inconsistent [83,84].…”