Loffi Marco, Piccolo Raffaele, Regazzoni Valentina, Di Tano Giuseppe, Moschini Luigi, Robba Debora, Quinzani Filippo, Esposito Giovanni, Franzone Anna, Danzi Gian Battista
Division of Cardiology, Hospital of Cremona, Cremona, Italy
University of Naples Federico II Department of Advanced Biomedical Sciences, Napoli, Campania, Italy.
Open Heart. 2020 Nov;7(2). doi: 10.1136/openhrt-2020-001428.
Among 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.
We 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.
Of 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.
Patients 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.
在2019冠状病毒病（COVID-19）患者中，冠状动脉疾病（CAD）已被确定为一种高危情况。我们旨在根据CAD状态评估COVID-19患者的临床结局和死亡率。
我们回顾性分析了2020年2月至3月期间入住意大利伦巴第地区克雷莫纳医院的COVID-19患者的数据。主要结局是全因死亡率。CAD被定义为既往有心肌梗死（MI）病史、既往接受过经皮冠状动脉介入治疗（PCI）、既往接受过冠状动脉旁路移植术（CABG）或正在接受药物治疗的CAD。
在1252例连续的COVID-19患者中，124例（9.9%）合并CAD。与无CAD的患者相比，CAD患者年龄更大，合并症患病率更高。尽管CAD患者的全因死亡率风险高于无CAD的患者（HR 3.01，95%CI 2.27至3.99），但在调整模型中这种差异不再显著（HR 1.14，95%CI 0.79至1.63）。在既往有MI的患者（调整后HR（aHR）0.87，95%CI 0.54至1.41）、既往接受PCI的患者（aHR 1.10，95%CI 0.75至1.62）、既往接受CABG的患者（aHR 0.91，95%CI 0.45至1.82）或接受药物治疗的CAD患者（aHR 0.84，95%CI 0.29至2.44）中，结果是一致的。多变量分析显示，年龄（每增加5岁aHR 1.62，95%CI 1.53至1.72）和女性（aHR 0.63，95%CI 0.49至0.82）是仅有的两个与死亡率独立相关的因素。
COVID-19合并CAD的患者死亡率极高，这主要归因于合并症的负担，而非CAD本身的直接影响。
