Key result
CAC >31 linked to ~131% higher risk of ICU admission or death in hospitalized COVID-19 patients.
Why the study?
Cardiovascular comorbidity significantly impacts COVID-19 mortality, prompting investigation into whether coronary calcification as a marker for CAD is appropriate for risk prediction in COVID-19.
Does a higher coronary calcium score predict critical or fatal outcomes in hospitalized patients with COVID-19?
Observational (n=109)
No
Does a higher coronary calcium score predict critical or fatal outcomes in hospitalized patients with COVID-19?
Hazard Ratio: 2.31 (95% CI 1.28–4.17)
p-value: p=0.0056
Coronary calcium scoring on screening chest CT is a significant predictor of critical illness and death in hospitalized COVID-19 patients.
May refine COVID-19 prognosis via routine chest CT; leaves open whether CAC improves risk stratification or changes management.
BACKGROUND: Since the outbreak of the COVID-19 pandemic, a number of risk factors for a poor outcome have been identified. Thereby, cardiovascular comorbidity has a major impact on mortality. We investigated whether coronary calcification as a marker for coronary artery disease (CAD) is appropriate for risk prediction in COVID-19. METHODS: Hospitalized patients with COVID-19 (n = 109) were analyzed regarding clinical outcome after native computed tomography (CT) imaging for COVID-19 screening. CAC (coronary calcium score) and clinical outcome (need for intensive care treatment or death) data were calculated following a standardized protocol. We defined three endpoints: critical COVID-19 and transfer to ICU, fatal COVID-19 and death, composite endpoint critical and fatal COVID-19, a composite of ICU treatment and death. We evaluated the association of clinical outcome with the CAC. Patients were dichotomized by the median of CAC. Hazard ratios and odds ratios were calculated for the events death or ICU or a composite of death and ICU. RESULTS: We observed significantly more events for patients with CAC above the group's median of 31 for critical outcome (HR: 1.97[1.09,3.57], p = 0.026), for fatal outcome (HR: 4.95[1.07,22.9], p = 0.041) and the composite endpoint (HR: 2.31[1.28,4.17], p = 0.0056. Also, odds ratio was significantly increased for critical outcome (OR: 3.01 [1.37, 6.61], p = 0.01) and for fatal outcome (OR: 5.3 [1.09, 25.8], p = 0.02). CONCLUSION: The results indicate a significant association between CAC and clinical outcome in COVID-19. Our data therefore suggest that CAC might be useful in risk prediction in patients with COVID-19.
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Zimmermann et al. (2020) conducted an observational in COVID-19 (n=109). Coronary artery calcification (CAC) above the median (>31) vs. CAC below or equal to the median (≤31) was evaluated on Composite of critical (ICU admission) and fatal (death) COVID-19 (HR 2.31, 95% CI 1.28-4.17, p=0.0056). In hospitalized COVID-19 patients, a coronary calcium score above the median of 31 significantly increased the risk of the composite endpoint of ICU admission or death (HR 2.31).