Key result
The absence of coronary artery calcium (CAC score = 0) was independently associated with a significantly lower risk of major adverse cardiovascular events (OR 0.209) in hospitalized COVID-19 patients.
Why the study?
Cardiovascular risk factors associate with poor COVID-19 prognosis, but whether the absence of coronary artery calcium (CAC) has predictive value for improved cardiovascular outcomes in hospitalized COVID-19 patients remained unproven.
Does the absence of coronary artery calcium (CAC score = 0) predict a lower rate of major adverse cardiovascular events in hospitalized COVID-19 patients?
Cohort (n=280)
No
Does the absence of coronary artery calcium (CAC score = 0) predict a lower rate of major adverse cardiovascular events in hospitalized COVID-19 patients?
Odds Ratio: 0.209 (95% CI 0.052–0.833)
p-value: p=0.027
The absence of coronary artery calcium on routine non-gated chest CT has a high negative predictive value for in-hospital major adverse cardiovascular events in COVID-19 patients.
May inform prognosis in hospitalized COVID-19; hypothesis-generating and requires prospective validation.
Background: The association of known cardiovascular risk factors with poor prognosis of coronavirus disease 2019 (COVID-19) has been recently emphasized. Coronary artery calcium (CAC) score is considered a risk modifier in the primary prevention of cardiovascular disease. We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients. Materials and methods: We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with history of coronary artery disease were excluded. Chest computed tomography (CT) was performed in all patients. Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in-hospital treatment, and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined. Results: Two hundred eighty patients (63.2 ± 16.7 years old, 57.5% male) were included in the analysis. 46.7% patients had a CAC score of 0. MACE rate was 21.8% (61 patients). The absence of CAC was inversely associated with MACE (OR 0.209, 95% CI 0.052–0.833, p = 0.027), with a negative predictive value of 84.5%. Conclusion: The absence of CAC had a high negative predictive value for MACE in patients hospitalized with COVID-19, even in the presence of cardiac risk factors. A semi-qualitative assessment of CAC is a simple, reproducible, and non-invasive measure that may be useful to identify COVID-19 patients at a low risk for developing cardiovascular complications.
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Luchian et al. (2021) conducted a cohort in COVID-19 (n=280). Absence of coronary artery calcium (CAC score = 0) vs. Presence of coronary artery calcium (CAC score ≥ 1) was evaluated on Composite of major adverse cardiovascular events (MACE) defined as all-cause mortality, heart failure, acute coronary syndrome, atrial fibrillation, and stroke (OR 0.209, 95% CI 0.052-0.833, p=0.027). The absence of coronary artery calcium (CAC score = 0) was independently associated with a significantly lower risk of major adverse cardiovascular events (OR 0.209) in hospitalized COVID-19 patients.
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