Impact of the “atherosclerotic pabulum” on in‐hospital mortality for SARS‐CoV‐2 infection. Is calcium score able to identify at‐risk patients?

Abstract

Background Although the primary cause of death in COVID‐19 infection is respiratory failure, there is evidence that cardiac manifestations may contribute to overall mortality and can even be the primary cause of death. More importantly, it is recognized that COVID‐19 is associated with a high incidence of thrombotic complications. Hypothesis Evaluate if the coronary artery calcium (CAC) score was useful to predict in‐hospital (in‐H) mortality in patients with COVID‐19. Secondary end‐points were needed for mechanical ventilation and intensive care unit admission. Methods Two‐hundred eighty‐four patients (63, 25 years, 67% male) with proven severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection who had a noncontrast chest computed tomography were analyzed for CAC score. Clinical and radiological data were retrieved. Results Patients with CAC had a higher inflammatory burden at admission ( d ‐dimer, p = .002; C‐reactive protein, p = .002; procalcitonin, p = .016) and a higher high‐sensitive cardiac troponin I (HScTnI, p = <.001) at admission and at peak. While there was no association with presence of lung consolidation and ground‐glass opacities, patients with CAC had higher incidence of bilateral infiltration ( p = .043) and higher in‐H mortality ( p = .048). On the other side, peak HScTnI >200 ng/dl was a better determinant of all outcomes in both univariate ( p = <.001) and multivariate analysis ( p = <.001). Conclusion The main finding of our research is that CAC was positively related to in‐H mortality, but it did not completely identify all the population at risk of events in the setting of COVID‐19 patients. This raises the possibility that other factors, including the presence of soft, unstable plaques, may have a role in adverse outcomes in SARS‐CoV‐2 infection.

Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran

“… 28 did not find age to be an independent predictor of death in COVID-19 patients. In contrast, many studies have recognized age as an independent predictor of death in COVID-19 patients 32 , 34 , 35 , 42 , 43 . This disparity can be attributed to differences in study populations, as our patients had a lower mean age compared to previous studies.…”

“… 33 reported that ICU admission and longer ICU stay were associated with higher odds of mortality in COVID-19 patients with CAC scores above the median. However, some studies have not reported a significant association between CAC score and ICU admission or length of ICU stay 32 , 34 , 35 . This variability in findings could be attributed to differences in patient categorization based on CAC score, sample size, or CAC scoring method.…”

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

“…At the same time, in the context of sepsis, reflex tachycardia increases the myocardial oxygen demand. Of course, the presence of atheroma plaques is a risk factor for the unfavorable evolution in patients with sepsis, increasing the risk of acute myocardial injury [ 61 , 62 ], but COVID-19 is also highly associated with non-atherosclerotic coronary perfusion impairment, such as spasm of the coronary arteries, dissection of the coronary wall, microthrombosis in the context of the hypercoagulant state, or vasculitis-like injury of the coronary vessels [ 63 , 64 ]. Regardless of the intimate mechanism of COVID-19-related myocardial infarction with non-obstructive coronary arteries, the patients’ prognosis is poor, with high mortality rates mainly due to the increased prevalence of severe comorbidities, such as ARDS, obesity, or congenital thrombophilia [ 64 , 65 ].…”

Correlation among semiquantitative High‐Resolution Computed Tomography severity scores and clinical and biochemical parameters in COVID‐19, is it really effective?

“…Moreover, there are no specifications about the type of coexisting comorbidities since the severity of COVID-19 pneumonia could have been related to many pathologies, above all cardiovascular disease. 4 In our opinion, images should have been reviewed by at least two expert radiologists for more reliable detection of radiological signs in HRCTs. This method should have been reported in the study's limitations.…”