Chin J Acad Radiol . Coronary artery calcification and risk of mortality and adverse outcomes in patients with COVID-19: a Chinese multicenter retrospective cohort study

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Chin J Acad Radiol


. 2021 Jun 28;1-9.
doi: 10.1007/s42058-021-00072-4. Online ahead of print.
Coronary artery calcification and risk of mortality and adverse outcomes in patients with COVID-19: a Chinese multicenter retrospective cohort study


Song Luo ^{# 1} , Xiao Ming Qiu ^{# 2} , Xian Jun Zeng ³ , Dong You Zhang ^{# 4} , Bing Wan ⁵ , Xiao Li ^{1 6} , Rong Hua Tian ⁷ , Jiang Tao Wang ⁸ , Mei Yun Wang ⁹ , Juan Zhu ¹⁰ , Can Zhang ¹¹ , Ran Yang ¹² , Feng Chen ¹³ , Yi Liang ¹⁴ , Bin Fan ¹⁵ , Hui Jie Jiang ¹⁶ , Xi Ming Wang ¹⁷ , Wei Chen ¹⁸ , Kai Xu ¹⁹ , Jian Bo Gao ²⁰ , Chao Du ²¹ , Li Na Zhang ²² , Yi Yang ⁴ , Shi Jun Jia ⁸ , Hao Ren ⁸ , Zi Yue Zu ¹ , Peng Peng Xu ¹ , Jing Zhong ¹ , Yu Ting Yang ¹ , Chang Sheng Zhou ¹ , Wei Zhang ¹ , Xiao Xue Liu ¹ , Qi Rui Zhang ¹ , Fei Xia ¹ , Li Qi ¹ , Meng Jie Lu ¹ , Long Jiang Zhang ¹ , Yu Xiu Liu ²³ , Guang Ming Lu ¹



Affiliations

• PMID: 34222797
• PMCID: PMC8237549
• DOI: 10.1007/s42058-021-00072-4

Abstract

Background: Coronary artery calcification (CAC) is an independent risk factor of major adverse cardiovascular events; however, the impact of CAC on in-hospital death and adverse clinical outcomes in patients with coronavirus disease 2019 (COVID-19) remains unclear.
Objective: To explore the association between CAC and in-hospital mortality and adverse events in patients with COVID-19.
Methods: This multicenter retrospective cohort study enrolled 2067 laboratory-confirmed COVID-19 patients with definitive clinical outcomes (death or discharge) admitted from 22 tertiary hospitals in China between January 3, 2020 and April 2, 2020. Demographic, clinical, laboratory results, chest CT findings, and CAC on admission were collected. The primary outcome was in-hospital death and the secondary outcome was composed of in-hospital death, admission to intensive care unit (ICU), and requiring mechanical ventilation. Multivariable Cox regression analysis and Kaplan-Meier plots were used to explore the association between CAC and in-hospital death and adverse clinical outcomes.
Results: The mean age was 50 years (SD,16) and 1097 (53.1%) were male. A total of 177 patients showed high CAC level, and compared with patients with low CAC, these patients were older (mean age: 49 vs. 69 years, P < 0.001) and more likely to be male (52.0% vs. 65.0%, P = 0.001). Comorbidities, including cardiovascular disease (CVD) ([33.3%, 59/177] vs. [4.7%, 89/1890], P < 0.001), presented more often among patients with high CAC, compared with patients with low CAC. As for laboratory results, patients with high CAC had higher rates of increased D-dimer, LDH, as well as CK-MB (all P < 0.05). The mean CT severity score in high CAC group was also higher than low CAC group (12.6 vs. 11.1, P = 0.005). In multivariable Cox regression model, patients with high CAC were at a higher risk of in-hospital death (hazard ratio [HR], 1.731; 95% CI 1.010-2.971, P = 0.046) and adverse clinical outcomes (HR, 1.611; 95% CL 1.087-2.387, P = 0.018).
Conclusion: High CAC is a risk factor associated with in-hospital death and adverse clinical outcomes in patients with confirmed COVID-19, which highlights the importance of calcium load testing for hospitalized COVID-19 patients and calls for attention to patients with high CAC.
Supplementary information: The online version contains supplementary material available at 10.1007/s42058-021-00072-4.

Keywords: Cardiovascular disease; Coronary artery calcification; Coronavirus disease 2019; Mortality.