Coronary artery disease in patients hospitalised with Coronavirus disease 2019 (COVID-19) infection

Abstract

ObjectiveAmong patients with Coronavirus disease 2019 (COVID-19), coronary artery disease (CAD) has been identified as a high-risk condition. We aimed to assess the clinical outcomes and mortality among patients with COVID-19 according to CAD status.MethodsWe retrospectively analysed data from patients with COVID-19 admitted to the Cremona Hospital (Lombardy region, Italy) between February and March 2020. The primary outcome was all-cause mortality. CAD was defined as a history of prior myocardial infarction (MI), prior percutaneous coronary intervention (PCI), prior coronary artery bypass grafting (CABG) or CAD that was being medically treated.ResultsOf 1252 consecutive patients with COVID-19, 124 (9.9%) had concomitant CAD. Patients with CAD were older and had a higher prevalence of comorbidities compared with those without CAD. Although patients with CAD had a higher risk of all-cause mortality than patients without CAD (HR 3.01, 95% CI 2.27 to 3.99), this difference was no longer significant in the adjusted model (HR 1.14, 95% CI 0.79 to 1.63). Results were consistent among patients with prior MI (adjusted HR (aHR) 0.87, 95% CI 0.54 to 1.41), prior PCI (aHR 1.10, 95% CI 0.75 to 1.62), prior CABG (aHR 0.91, 95% CI 0.45 to 1.82), or CAD medically treated (aHR 0.84, 95% CI 0.29 to 2.44). Multivariable analysis showed that age (aHR per 5 year increase 1.62, 95% CI 1.53 to 1.72) and female sex (aHR 0.63, 95% CI 0.49 to 0.82) were the only two independent correlates of mortality.ConclusionPatients with COVID-19 and CAD have an exceedingly higher risk of mortality, which is mainly attributable to the burden of comorbidities rather than to a direct effect of CAD per se.

Prolonged Oxygen Therapy Post COVID-19 Infection: Factors Leading to the Risk of Poor Outcome

“…In our study, it was 11/93 (11.8%). The average age of patients with CAD is known to be older with a male predominance [ 21 ]. Ninety percent of the patients with CAD in our study were males and their mean age was 14.4±7.3 years older than that of patients without CAD.…”

“…Ninety percent of the patients with CAD in our study were males and their mean age was 14.4±7.3 years older than that of patients without CAD. Several studies have reported an increased risk of ARDS, CCU admission, need for ventilation, and death in patients with CAD with COVID-19 infection, however it is not very clear to what extent the increased risk is attributable to CAD as an independent risk factor [ 20 , 21 ]. The patients with CAD in our study had significantly higher risk of adverse outcome with respect to prolonged hospital admission, oxygen therapy, CCU admission, and death; multivariable regression analysis calculated an OR of 12.22 (95%CI 2.4-61.5, p<0.002) for failure to wean and delayed recovery in patients with CAD aged >50 years having multiple co-morbidities.…”

“…In a study from Italy, the unadjusted probability of death in the patients with CAD was 0.49 compared to 0.20 in those without CAD. However, after multivariable analysis and adjusted hazard ratio (aHR), the study concluded that although patients with CAD with COVID-19 infection have a very high risk of mortality, it can be attributed to the burden of other co-morbidities rather than due to CAD per se [ 21 ]. The two variables which were independently associated with all-cause mortality in their study were advanced age (added to the risk) and female gender (reduced the risk) [ 21 ].…”

Meta-Analysis of Atrial Fibrillation in Patients With COVID-19

“…Nine hundred and sixteen potentially relevant studies were screened according to the inclusion and exclusion criteria. Finally, 23 studies with 108,745 COVID-19 patients 1 , 2 , 3 , 4 , 5 , 6 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 were eligibly included in the present quantitative meta-analysis. The study characteristics are summarized in Table 1 .…”

Percutaneous coronary intervention in patients with COVID‐19 and acute coronary syndrome: What if the old normal became the new normal?

“…Consequently, as long as invasive assessment can be safely and timely performed, 4 we should go back to the “normal” guidelines supporting primary PCI and early invasive strategy for the majority of patients with ST‐elevation and non‐ST‐elevation ACS, respectively. Data suggest that patients with concomitant coronary artery disease and COVID‐19 have a threefold higher risk of mortality, 5 which is mainly explained by the burden of comorbidities. Hence, invasive angiography with the possibility of revascularization not only should not be withheld in COVID‐19 patients with ACS, but rather supported as the authors brilliantly did.…”