COVID-19 相关住院期间的急性心脏事件。
Acute Cardiac Events During COVID-19-Associated Hospitalizations.
机构信息
COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; United States Public Health Service Commissioned Corps, Rockville, Maryland, USA.
出版信息
J Am Coll Cardiol. 2023 Feb 14;81(6):557-569. doi: 10.1016/j.jacc.2022.11.044.
BACKGROUND
COVID-19 is associated with cardiac complications.
OBJECTIVES
The purpose of this study was to estimate the prevalence, risk factors, and outcomes associated with acute cardiac events during COVID-19-associated hospitalizations among adults.
METHODS
During January 2021 to November 2021, medical chart abstraction was conducted on a probability sample of adults hospitalized with laboratory-confirmed SARS-CoV-2 infection identified from 99 U.S. counties in 14 U.S. states in the COVID-19-Associated Hospitalization Surveillance Network. We calculated the prevalence of acute cardiac events (identified by International Classification of Diseases-10th Revision-Clinical Modification codes) by history of underlying cardiac disease and examined associated risk factors and disease outcomes.
RESULTS
Among 8,460 adults, 11.4% (95% CI: 10.1%-12.9%) experienced an acute cardiac event during a COVID-19-associated hospitalization. Prevalence was higher among adults who had underlying cardiac disease (23.4%; 95% CI: 20.7%-26.3%) compared with those who did not (6.2%; 95% CI: 5.1%-7.6%). Acute ischemic heart disease (5.5%; 95% CI: 4.5%-6.5%) and acute heart failure (5.4%; 95% CI: 4.4%-6.6%) were the most prevalent events; 0.3% (95% CI: 0.1%-0.5%) experienced acute myocarditis or pericarditis. Risk factors varied by underlying cardiac disease status. Patients with ≥1 acute cardiac event had greater risk of intensive care unit admission (adjusted risk ratio: 1.9; 95% CI: 1.8-2.1) and in-hospital death (adjusted risk ratio: 1.7; 95% CI: 1.3-2.1) compared with those who did not.
CONCLUSIONS
Acute cardiac events were common during COVID-19-associated hospitalizations, particularly among patients with underlying cardiac disease, and are associated with severe disease outcomes. Persons at greater risk for experiencing acute cardiac events during COVID-19-associated hospitalizations might benefit from more intensive clinical evaluation and monitoring during hospitalization.
背景
COVID-19 与心脏并发症有关。
目的
本研究旨在估计成年人 COVID-19 住院期间与急性心脏事件相关的患病率、风险因素和结局。
方法
在 2021 年 1 月至 2021 年 11 月期间，对从美国 14 个州的 99 个县的 COVID-19 相关住院监测网络中确定的实验室确诊 SARS-CoV-2 感染的成年人进行概率抽样，对其病历进行了病历摘录。我们通过基础心脏疾病史计算了急性心脏事件（通过国际疾病分类第 10 次修订临床修正版代码确定）的患病率，并检查了相关的风险因素和疾病结局。
结果
在 8460 名成年人中，11.4%（95%置信区间：10.1%-12.9%）在 COVID-19 相关住院期间发生急性心脏事件。有基础心脏疾病的成年人的患病率（23.4%；95%置信区间：20.7%-26.3%）高于没有基础心脏疾病的成年人（6.2%；95%置信区间：5.1%-7.6%）。急性缺血性心脏病（5.5%；95%置信区间：4.5%-6.5%）和急性心力衰竭（5.4%；95%置信区间：4.4%-6.6%）是最常见的事件；0.3%（95%置信区间：0.1%-0.5%）发生急性心肌炎或心包炎。风险因素因基础心脏疾病状况而异。发生≥1 次急性心脏事件的患者入住重症监护病房的风险增加（调整风险比：1.9；95%置信区间：1.8-2.1）和院内死亡的风险增加（调整风险比：1.7；95%置信区间：1.3-2.1）。
结论
COVID-19 相关住院期间急性心脏事件较为常见，尤其是在有基础心脏疾病的患者中，且与严重的疾病结局相关。在 COVID-19 相关住院期间发生急性心脏事件风险较高的患者可能受益于住院期间更强化的临床评估和监测。
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