Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes

Abstract

Background: Recent studies have demonstrated a complex interplay between comorbid cardiovascular disease, COVID-19 pathophysiology, and poor clinical outcomes. Coronary artery calcification (CAC) may therefore aid in risk stratification of COVID-19 patients. Methods: Non-contrast chest CT studies on 180 COVID-19 patients ≥ age 21 admitted from March 1, 2020 to April 27, 2020 were retrospectively reviewed by two radiologists to determine CAC scores. Following feature selection, multivariable logistic regression was utilized to evaluate the relationship between CAC scores and patient outcomes. Results: The presence of any identified CAC was associated with intubation (AOR: 3.6, CI: 1.4-9.6) and mortality (AOR: 3.2, CI: 1.4-7.9). Severe CAC was independently associated with intubation (AOR: 4.0, CI: 1.3-13) and mortality (AOR: 5.1, CI: 1.9-15). A greater CAC score (UOR: 1.2, CI: 1.02-1.3) and number of vessels with calcium (UOR: 1.3, CI: 1.02-1.6) was associated with mortality. Visualized coronary stent or coronary artery bypass graft surgery (CABG) had no statistically significant association with intubation (AOR: 1.9, CI: 0.4-7.7) or death (AOR: 3.4, CI: 1.0-12). Conclusion: COVID-19 patients with any CAC were more likely to require intubation and die than those without CAC. Increasing CAC and number of affected arteries was associated with mortality. Severe CAC was associated with higher intubation risk. Prior CABG or stenting had no association with elevated intubation or death.

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

“…However, it is relevant to underline that all consecutive patients by each participating center were enrolled. Moreover, our study population's clinical, laboratory, and outcome features were consistent with those previously reported in the literature for COVID-19 [17][18][19][20].…”

Coronary calcium score as a predictor of outcomes in the hypertensive Covid-19 population: results from the Italian (S) Core-Covid-19 Registry

“…CACS can be easily measured from chest CT performed for pneumonia assessment [ 7 , 9 , 16 – 18 ], and CACS has been demonstrated to be a strong independent predictor of future cardiovascular events [ 16 , 17 ].…”

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

“…Of note, even though coronary artery calcium was detected in half (50.7%) of the patients in the Dillinger study [15], the overall plaque burden was relatively low with a median CACS of 8 (IQR: 0-116) [15]. Recently, Gupta et al [16] conducted a similar study on 108 hospitalized patients with COVID-19 and showed that CACS were associated with the primary outcome of intubation/death, and the secondary outcome of elevated D-dimer. Similar to the study by Dillinger [15], they found both the presence of calcified plaque and extent of plaque were associated with worst outcomes even after adjusting for a broad set of demographic, clinical and laboratory covariates.…”

“…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. CACS were computed from clinically indicated non-gated chest computed tomography (CT) scans and patients were divided into 3 categories of coronary artery disease (CAD): no CAD (CACS = 0), prior CAD (history of previous surgical or percutaneous coronary revascularization) or subclinical CAD (further classified based on CACS as mild: ≤100; moderate: 100-400; and severe: >400).…”

“…Similar to the study by Dillinger [15], they found both the presence of calcified plaque and extent of plaque were associated with worst outcomes even after adjusting for a broad set of demographic, clinical and laboratory covariates. However, two points of difference in Gupta et al [16] when compared to the Dillinger study [15] are the use of non-gated CT scans done within 3 months prior to or after admission, and CACS quantification using an ordinal scoring method [17].…”