Abstract
Purpose: The purpose of this study was to evaluate the association between coronary artery calcium (CAC) visual score and 6-month mortality in patients with coronavirus disease 2019 (COVID-19).
Material and methods: A single-center prospective observational cohort was conducted in 169 COVID-19 consecutive hospitalized patients between March 13 and April 1, 2020, and follow-up for 6-months. A four-level visual CAC scoring was assessed by analyzing images obtained after the first routine non-ECG-gated CT performed to detect COVID-19 pneumonia.
Results: Among 169 confirmed COVID-19 patients (118 men, 51 women; mean age, 65.6 ± 18.8 [SD] years; age range: 30-95 years) 63 (37%) presented with either moderate (n = 26, 15.3%) or heavy (n = 37, 21.8%) CAC detected by CT and 20 (11.8%) had history of cardiovascular disease requiring specific preventive treatment. At six months, mortality rate (45/169; 26.6%) increased with magnitude of CAC and was 7/64 (10.9%), 11/42 (26.2%), 10/26 (38.5%), 17/37 (45.9%) for no-CAC, mild-CAC, moderate-CAC and heavy-CAC groups, respectively (P = 0.001). Compared to the no CAC group, risk of death increased after adjustment with magnitude of CAC (HR: 2.23, 95% CI: 0.73-6.87, P = 0.16; HR: 2.78, 95% CI: 0.85-9.07, P0.09; HR: 5.38, 95% CI: 1.57-18.40, P = 0.007; in mild CAC, moderate and heavy CAC groups, respectively). In patients without previous coronary artery disease (154/169; 91%), mortality increased from 10.9% to 45.8% (P = 0.001) according to the magnitude of CAC categories. After adjustment, presence of moderate or heavy CAC was associated with higher mortality (HR: 2.26, 95% CI: 1.09-4.69, P = 0.03).
Conclusion: By using non-ECG-gated CT during the initial pulmonary assessment of COVID-19, heavy CAC is independently associated with 6-month mortality in patients hospitalized for severe COVID-19 pneumonia.
Keywords: COVID-19; Computed tomography; Coronary artery calcification; Myocardial injury; Outcomes.
【저자키워드】 COVID-19, outcomes, Computed tomography, myocardial injury, Coronary artery calcification, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, Severe COVID-19 pneumonia, COVID-19 pneumonia, Mortality, Pneumonia, cardiovascular disease, Coronary artery disease, Computed tomography, myocardial injury, Patient, Mild, age, Follow-up, mortality rate, moderate, calcium, association, COVID-19 patient, Coronary artery, preventive treatment, risk of death, 95% CI, categories, single-center, material, men, initial, performed, detect, evaluate, conducted, hospitalized patient, magnitude, groups, patients hospitalized, prospective observational cohort, 【제목키워드】 Mortality, hospitalized patient, with COVID-19,