Key result
Pre-existing coronary artery disease in COVID-19 patients was associated with higher mortality (CAD prevalence 9.2% in survivors vs 22.9% in non-survivors; OR 0.33; 95% CI 0.29-0.39; p<0.001).
Why the study?
Patients with pre-existing CAD were shown to have a more severe course of COVID-19, but this association had not been clarified.
Does pre-existing coronary artery disease worsen prognosis and increase mortality in patients with COVID-19?
Meta-Analysis (n=49,286)
Does pre-existing coronary artery disease worsen prognosis and increase mortality in patients with COVID-19?
Odds Ratio: 0.33 (95% CI 0.29–0.39)
Absolute Event Rate: 9.2% vs 22.9%
p-value: p=< 0.001
Pre-existing coronary artery disease is significantly associated with higher mortality, increased disease severity, and more frequent ICU admission in patients with COVID-19.
May warrant closer monitoring for CAD patients with COVID-19; confirms association in observational meta-analysis but leaves causality and practice change open.
Coronary artery disease (CAD) is the leading cause of death worldwide. Patients with pre-existing CAD were shown to have a more severe course of COVID-19, but this association has not been clarified. We performed a meta-analysis to determine the association between CAD and COVID-19 outcomes. We searched Scopus, Medline (PubMed), Web of Science, Embase, and Cochrane databases up to 2 November 2021. There were 62 studies with a total population of 49,286 patients included in the meta-analysis. CAD occurrence in survivor vs. non-survivor groups varied and amounted to 9.2% vs. 22.9%, respectively (OR = 0.33; 95%CI: 0.29 to 0.39; I2 = 70%; p < 0.001). CAD was also associated with increased severity of COVID-19 disease and was (10.8% vs. 5.6%, respectively, for severe vs. non-severe groups (OR = 2.28; 95%CI: 1.59 to 3.27; I2 = 72%; p < 0.001). The role of history of CAD in mortality and severe condition in COVID-19 presents itself as prominent—although a risk of bias in retrospective trials needs to be assessed, in case of our meta-analysis the statistically significant results when it comes to higher mortality among patients with CAD compared to non-CAD patients, a more severe condition observed in patients with CAD, and a visibly more frequent admission to intensive care unit in patients with CAD, it seems that an incidence of cardiovascular events plays a role in COVID-19 prognosis.
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Szarpak et al. (2022) conducted a meta-analysis in COVID-19 and Coronary Artery Disease (n=49,286). Coronary artery disease (CAD) vs. No CAD was evaluated on Mortality (CAD occurrence in survivor vs. non-survivor groups) (OR 0.33, 95% CI 0.29 to 0.39, p=< 0.001). Pre-existing coronary artery disease in COVID-19 patients was associated with higher mortality (CAD prevalence 9.2% in survivors vs 22.9% in non-survivors; OR 0.33; 95% CI 0.29-0.39; p<0.001).
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