Coronary artery disease in patients hospitalised with Coronavirus disease 2019 (COVID-19) infection

• Published in: Open heart Vol. 7; no. 2; p. e001428
• Main Authors: Loffi, Marco, Piccolo, Raffaele, Regazzoni, Valentina, Di Tano, Giuseppe, Moschini, Luigi, Robba, Debora, Quinzani, Filippo, Esposito, Giovanni, Franzone, Anna, Danzi, Gian Battista
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 23.11.2020; BMJ Publishing Group
• Series: Original research
• Subjects: Age Factors; Aged; Aged, 80 and over; Atherosclerosis; Cardiovascular disease; Cause of Death; Comorbidity; Coronary Artery Disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - mortality; COVID-19 - therapy; Female; Hospital Mortality; Hospitalization; Humans; Italy - epidemiology; Male; Middle Aged; Mortality; Prevalence; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Italy; atherosclerosis; coronary artery disease; risk stratification
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2020-001428

ObjectiveAmong patients with Coronavirus disease 2019 (COVID-19), coronary artery disease (CAD) has been identified as a high-risk condition. We aimed to assess the clinical outcomes and mortality among patients with COVID-19 according to CAD status.MethodsWe retrospectively analysed data from patients with COVID-19 admitted to the Cremona Hospital (Lombardy region, Italy) between February and March 2020. The primary outcome was all-cause mortality. CAD was defined as a history of prior myocardial infarction (MI), prior percutaneous coronary intervention (PCI), prior coronary artery bypass grafting (CABG) or CAD that was being medically treated.ResultsOf 1252 consecutive patients with COVID-19, 124 (9.9%) had concomitant CAD. Patients with CAD were older and had a higher prevalence of comorbidities compared with those without CAD. Although patients with CAD had a higher risk of all-cause mortality than patients without CAD (HR 3.01, 95% CI 2.27 to 3.99), this difference was no longer significant in the adjusted model (HR 1.14, 95% CI 0.79 to 1.63). Results were consistent among patients with prior MI (adjusted HR (aHR) 0.87, 95% CI 0.54 to 1.41), prior PCI (aHR 1.10, 95% CI 0.75 to 1.62), prior CABG (aHR 0.91, 95% CI 0.45 to 1.82), or CAD medically treated (aHR 0.84, 95% CI 0.29 to 2.44). Multivariable analysis showed that age (aHR per 5 year increase 1.62, 95% CI 1.53 to 1.72) and female sex (aHR 0.63, 95% CI 0.49 to 0.82) were the only two independent correlates of mortality.ConclusionPatients with COVID-19 and CAD have an exceedingly higher risk of mortality, which is mainly attributable to the burden of comorbidities rather than to a direct effect of CAD per se.