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      Coronary artery calcifications and 6-month mortality in patients with COVID-19 without known atheromatous disease Translated title: Calcifications des artères coronaires et mortalité à 6 mois chez les patients COVID-19 sans maladie athéromateuse connue

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      a , b , c , d , b , c , e , b , f , b , c , b , c , b , c , e , b , c , f , *
      Archives of Cardiovascular Diseases
      Elsevier Masson SAS.
      ACE, angiotensin-converting enzyme, ARB, angiotensin-II receptor blocker, ASCVD, atherosclerotic cardiovascular disease, CAC, coronary artery calcium, CI, confidence interval, COVID-19, coronavirus disease 2019, CT, computed tomography, HR, hazard ratio, RAS, renin-angiotensin system, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, COVID-19, Coronary artery disease, Myocardial injury, Risk stratification, Mortality, COVID-19, Coronaropathie, Lésion myocardique, Stratification du risque, Mortalité

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          Abstract

          Background: Coronary artery calcium (CAC) is an independent risk factor for major adverse cardiovascular events; however, its impact on coronavirus disease 2019 (COVID-19) mortality remains unclear, especially in patients without known atheromatous disease.

          Aims: To evaluate the association between CAC visual score and 6-month mortality in patients without history of atheromatous disease hospitalized with COVID-19 pneumonia.

          Methods: A single-centre observational cohort study was conducted, involving 293 consecutive patients with COVID-19 in Paris, France, between 13 March and 30 April 2020, with a 6-month follow-up. Patients with a history of ischaemic stroke or coronary or peripheral artery disease were excluded. The primary outcome was all-cause mortality at 6 months according to CAC score, which was assessed by analysing images obtained after the first routine non-electrocardiogram-gated computed tomography scan performed to detect COVID-19 pneumonia.

          Results: A total of 251 patients (mean age 64.8 ± 16.7 years) were included in the analysis. Fifty-one patients (20.3%) died within 6 months. The mortality rate increased with the magnitude of calcifications, and was 10/101 (9.9%), 15/66 (22.7%), 10/34 (29.4%) and 16/50 (32.0%) for the no CAC, mild CAC, moderate CAC and heavy CAC groups, respectively (P = 0.004). Compared with the no calcification group, adjusted risk of death increased progressively with CAC: hazard ratio (HR) 2.37 (95% confidence interval [CI] 1.06–5.27), HR 3.1 (95% CI 1.29–7.45) and HR 4.02 (95% CI 1.82–8.88) in the mild, moderate and heavy CAC groups, respectively.

          Conclusions: Non-electrocardiogram-gated computed tomography during the initial pulmonary assessment of patients with COVID-19 without atherosclerotic cardiovascular disease showed a high prevalence of mild, moderate and heavy CAC. CAC score was related to 6-month mortality, independent of conventional cardiovascular risk factors. These results highlight the importance of CAC scoring for patients hospitalized with COVID-19, and calls for attention to patients with high CAC.

          Résumé

          Contexte: La calcification des artères coronaires (CAC) est un facteur de risque indépendant d'événements cardiovasculaires majeurs; cependant, leur impact sur la mortalité de la maladie à coronavirus 2019 (COVID-19) reste peu clair, en particulier chez les patients sans maladie athéromateuse connue.

          Objectifs: Évaluer l'association entre le score visuel de CAC et la mortalité à 6 mois chez les patients sans antécédents de maladie athéromateuse hospitalisés pour une pneumonie à COVID-19.

          Méthodes: Etude observationnelle monocentrique ayant inclus 293 patients consécutifs hospitalisés pour une pneumonie à COVID-19, entre le 13 mars et le 30 avril 2020. Les patients ayant des antécédents d'accident vasculaire cérébral ischémique, de coronaropathie, ou d’artériopathie oblitérante des membres inférieurs ont été exclus. Le critère de jugement principal était la mortalité toutes causes confondues à 6 mois selon le score visuel de CAC (obtenu en analysant les images du scanner thoracique non synchronisé à l’ECG réalisé à l’admission pour détecter et quantifier l’atteinte pulmonaire au COVID-19).

          Résultats: Au total, 251 patients (64,8 ± 16,7 ans) ont été inclus dans notre analyse. Cinquante et un patients (20,3 %) sont décédés dans les 6 mois. Le taux de mortalité augmentait avec l'ampleur des calcifications et était de 10/101 (9,9 %), 15/66 (22,7 %), 10/34 (29,4 %) et 16/50 (32.0 %) pour les groupes sans CAC, avec CAC léger, modéré et important, respectivement (P = 0,004). Par rapport au groupe sans calcification, le risque ajusté de décès augmentait progressivement avec le CAC : HR 2,37 (IC95 % 1,06–5,27), HR 3,1 (IC95 % 1,29–7,45) et HR 4,02 (IC95 % 1,82–8,88) dans les groupes CAC léger, modéré et important, respectivement.

          Conclusions: L’utilisation du scanner thoracique non synchronisé à l’ECG lors de l'évaluation pulmonaire initiale des patients COVID-19 a permis de détecter une forte prévalence de patients présentant des calcifications coronaires à un stade léger, modéré et important. Le score CAC était lié à la mortalité à 6 mois indépendamment des facteurs de risque cardiovasculaire conventionnels. Ces résultats soulignent l'importance de l’intégration du score visuel de CAC pour la stratification du risque chez les patients hospitalisés pour une pneumopathie COVID-19.

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          Author and article information

          Journal
          Arch Cardiovasc Dis
          Arch Cardiovasc Dis
          Archives of Cardiovascular Diseases
          Elsevier Masson SAS.
          1875-2136
          1875-2128
          4 March 2022
          4 March 2022
          Affiliations
          [a ]Faculté de Médecine, Sorbonne Université, 75006 Paris, France
          [b ]Faculté de Médecine, Université de Paris, 75006 Paris, France
          [c ]Institut National de la Santé et de la Recherche Médicale, PARCC, UMR970, 75015 Paris, France
          [d ]CIC1418 and DMU CARTE, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
          [e ]Department of Radiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
          [f ]Department of Cardiology, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
          Author notes
          [* ]Corresponding author at: Department of Cardiology, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75015 Paris, France
          Article
          S1875-2136(22)00043-2
          10.1016/j.acvd.2022.02.007
          8895715
          e6970526-4412-4f1a-8eb8-070f4ba9f8b0
          © 2022 Elsevier Masson SAS. All rights reserved.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

          History
          : 21 October 2021
          : 10 February 2022
          : 10 February 2022
          Categories
          Article

          ace, angiotensin-converting enzyme,arb, angiotensin-ii receptor blocker,ascvd, atherosclerotic cardiovascular disease,cac, coronary artery calcium,ci, confidence interval,covid-19, coronavirus disease 2019,ct, computed tomography,hr, hazard ratio,ras, renin-angiotensin system,sars-cov-2, severe acute respiratory syndrome coronavirus 2,covid-19,coronary artery disease,myocardial injury,risk stratification,mortality,coronaropathie,lésion myocardique,stratification du risque,mortalité

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