Coronary artery disease in patients hospitalised with Coronavirus disease 2019 (COVID-19) infection. Issue 2 (23rd November 2020)

• Record Type: Journal Article
• Authors: Loffi, Marco; Piccolo, Raffaele; Regazzoni, Valentina; Di Tano, Giuseppe; Moschini, Luigi; Robba, Debora; Quinzani, Filippo; Esposito, Giovanni; Franzone, Anna; Danzi, Gian Battista
• Is Part Of: Open heart. Volume 7:Issue 2(2020)
• Publication Date: 2020-11-23
• Subjects: coronary artery disease -- atherosclerosis -- risk stratification; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2020-001428
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objective: Among 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. Methods: We 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. Results: Of 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. Conclusion: Patients 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.