新型冠状病毒肺炎住院患者急性心血管事件的预后影响——德国CORONA研究结果
Prognostic Impact of Acute Cardiovascular Events in COVID-19 Hospitalized Patients-Results from the CORONA Germany Study.
作者信息
Gunawardene Melanie A, Gessler Nele, Wohlmuth Peter, Heitmann Kathrin, Anders Philipp, Jaquet Kai, Herborn Christoph U, Arnold Dirk, Bein Berthold, Bergmann Martin W, Herrlinger Klaus R, Stang Axel, Schreiber Ruediger, Wesseler Claas, Willems Stephan
机构信息
Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, Germany.
Asklepios Proresearch, Research Institute, 20099 Hamburg, Germany.
出版信息
J Clin Med. 2021 Sep 2;10(17):3982. doi: 10.3390/jcm10173982.
BACKGROUND
Acute myocardial injury (AMJ), assessed by elevated levels of cardiac troponin, is associated with fatal outcome in coronavirus disease 2019 (COVID-19). However, the role of acute cardiovascular (CV) events defined by clinical manifestation rather than sole elevations of biomarkers is unclear in hospitalized COVID-19 patients.
OBJECTIVE
The aim of this study was to investigate acute clinically manifest CV events in hospitalized COVID-19 patients.
METHODS
From 1 March 2020 to 5 January 2021, we conducted a multicenter, prospective, epidemiological cohort study at six hospitals from Hamburg, Germany (a portion of the state-wide 45-center CORONA Germany cohort study) enrolling all hospitalized COVID-19 patients. Primary endpoint was occurrence of a clinically manifest CV-event.
RESULTS
In total, 132 CV-events occurred in 92 of 414 (22.2%) patients in the Hamburg-cohort: cardiogenic shock in 10 (2.4%), cardiopulmonary resuscitation in 12 (2.9%), acute coronary syndrome in 11 (2.7%), de-novo arrhythmia in 31 (7.5%), acute heart-failure in 43 (10.3%), myocarditis in 2 (0.5%), pulmonary-embolism in 11 (2.7%), thrombosis in 9 (2.2%) and stroke in 3 (0.7%). In the Hamburg-cohort, mortality was 46% (42/92) for patients with a CV-event and 33% (27/83) for patients with only AMJ without CV-event (OR 1.7, CI: (0.94-3.2), = 0.077). Mortality was higher in patients with CV-events (Odds ratio(OR): 4.8, 95%-confidence-interval(CI): [2.9-8]). Age (OR 1.1, CI: (0.66-1.86)), atrial fibrillation (AF) on baseline-ECG (OR 3.4, CI: (1.74-6.8)), systolic blood-pressure (OR 0.7, CI: (0.53-0.96)), potassium (OR 1.3, CI: (0.99-1.73)) and C-reactive-protein (1.4, CI (1.04-1.76)) were associated with CV-events.
CONCLUSION
Hospitalized COVID-19 patients with clinical manifestation of acute cardiovascular events show an almost five-fold increased mortality. In this regard, the emergence of arrhythmias is a major determinant.
背景
通过心肌肌钙蛋白水平升高评估的急性心肌损伤（AMJ）与2019冠状病毒病（COVID-19）的致命结局相关。然而，在住院的COVID-19患者中，由临床表现而非仅生物标志物升高所定义的急性心血管（CV）事件的作用尚不清楚。
目的
本研究旨在调查住院COVID-19患者中急性临床表现的CV事件。
方法
从2020年3月1日至2021年1月5日，我们在德国汉堡的六家医院进行了一项多中心、前瞻性、流行病学队列研究（全州45中心德国冠状病毒队列研究的一部分），纳入所有住院的COVID-19患者。主要终点是临床表现的CV事件的发生。
结果
在汉堡队列的414例患者中的92例（22.2%）共发生了132次CV事件：心源性休克10例（2.4%），心肺复苏12例（2.9%），急性冠状动脉综合征11例（2.7%），新发心律失常31例（7.5%），急性心力衰竭43例（10.3%），心肌炎2例（0.5%），肺栓塞11例（2.7%），血栓形成9例（2.2%），中风3例（0.7%）。在汉堡队列中，发生CV事件的患者死亡率为46%（42/92），仅发生AMJ而无CV事件的患者死亡率为33%（27/83）（比值比1.7，置信区间：（0.94 - 3.2），P = 0.077）。CV事件患者的死亡率更高（比值比（OR）：4.8，95%置信区间（CI）：[2.9 - 8]）。年龄（OR 1.1，CI：（0.66 - 1.86））、基线心电图上的心房颤动（AF）（OR 3.4，CI：（1.74 - 6.8））、收缩压（OR 0.7，CI：（0.53 - 0.96））、钾（OR 1.3，CI：（0.99 - 1.73））和C反应蛋白（1.4，CI（1.04 - 1.76））与CV事件相关。
结论
有急性心血管事件临床表现的住院COVID-19患者死亡率几乎增加了五倍。在这方面，心律失常的出现是一个主要决定因素。
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