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. 2021 Nov 1;22(11):818-827.
doi: 10.2459/JCM.0000000000001228.

In-hospital prognostic role of coronary atherosclerotic burden in COVID-19 patients

Fabio Fazzari  1   2 , Ottavia Cozzi  1   2 , Matteo Maurina  1   2 , Valeria Donghi  1   2 , Eleonora Indolfi  1   2 , Mirko Curzi  1   2 , Pier Pasquale Leone  1   2 , Francesco Cannata  1   2 , Giulio G Stefanini  1   2 , Arturo Chiti  1   3 , Renato Maria Bragato  1   2 , Lorenzo Monti  1   3 , Alexia Rossi  1   3 ; Humanitas COVID-19 Task Force
Affiliations

In-hospital prognostic role of coronary atherosclerotic burden in COVID-19 patients

Fabio Fazzari et al. J Cardiovasc Med (Hagerstown). .

Abstract

Aims: Currently, there are few available data regarding a possible role for subclinical atherosclerosis as a risk factor for mortality in Coronavirus Disease 19 (COVID-19) patients. We used coronary artery calcium (CAC) score derived from chest computed tomography (CT) scan to assess the in-hospital prognostic role of CAC in patients affected by COVID-19 pneumonia.

Methods: Electronic medical records of patients with confirmed diagnosis of COVID-19 were retrospectively reviewed. Patients with known coronary artery disease (CAD) were excluded. A CAC score was calculated for each patient and was used to categorize them into one of four groups: 0, 1-299, 300-999 and at least 1000. The primary endpoint was in-hospital mortality for any cause.

Results: The final population consisted of 282 patients. Fifty-seven patients (20%) died over a follow-up time of 40 days. The presence of CAC was detected in 144 patients (51%). Higher CAC score values were observed in nonsurvivors [median: 87, interquartile range (IQR): 0.0-836] compared with survivors (median: 0, IQR: 0.0-136). The mortality rate in patients with a CAC score of at least 1000 was significantly higher than in patients without coronary calcifications (50 vs. 11%) and CAC score 1-299 (50 vs. 23%), P < 0.05. After adjusting for clinical variables, the presence of any CAC categories was not an independent predictor of mortality; however, a trend for increased risk of mortality was observed in patients with CAC of at least 1000.

Conclusion: The correlation between CAC score and COVID-19 is fascinating and under-explored. However, in multivariable analysis, the CAC score did not show an additional value over more robust clinical variables in predicting in-hospital mortality. Only patients with the highest atherosclerotic burden (CAC ≥1000) could represent a high-risk population, similarly to patients with known CAD.

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