Department of Medical and Surgical Sciences University of Bologna Bologna Italy.
IRCCS Azienda Ospedaliero-Universitaria di Bologna Sant'Orsola Hospital Bologna Italy.
J Am Heart Assoc. 2023 Jul 18;12(14):e028939. doi: 10.1161/JAHA.122.028939. Epub 2023 Jul 14.
Background Empiric antimicrobial therapy with azithromycin is highly used in patients admitted to the hospital with COVID-19, despite prior research suggesting that azithromycin may be associated with increased risk of cardiovascular events. Methods and Results This study was conducted using data from the ISACS-COVID-19 (International Survey of Acute Coronavirus Syndromes-COVID-19) registry. Patients with a confirmed diagnosis of SARS-CoV-2 infection were eligible for inclusion. The study included 793 patients exposed to azithromycin within 24 hours from hospital admission and 2141 patients who received only standard care. The primary exposure was cardiovascular disease (CVD). Main outcome measures were 30-day mortality and acute heart failure (AHF). Among 2934 patients, 1066 (36.4%) had preexisting CVD. A total of 617 (21.0%) died, and 253 (8.6%) had AHF. Azithromycin therapy was consistently associated with an increased risk of AHF in patients with preexisting CVD (risk ratio [RR], 1.48 [95% CI, 1.06-2.06]). Receiving azithromycin versus standard care was not significantly associated with death (RR, 0.94 [95% CI, 0.69-1.28]). By contrast, we found significantly reduced odds of death (RR, 0.57 [95% CI, 0.42-0.79]) and no significant increase in AHF (RR, 1.23 [95% CI, 0.75-2.04]) in patients without prior CVD. The relative risks of death from the 2 subgroups were significantly different from each other (=0.01). Statistically significant association was observed between AHF and death (odds ratio, 2.28 [95% CI, 1.34-3.90]). Conclusions These findings suggest that azithromycin use in patients with COVID-19 and prior history of CVD is significantly associated with an increased risk of AHF and all-cause 30-day mortality. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05188612.
背景 在因 COVID-19 住院的患者中，经验性使用阿奇霉素进行抗菌治疗的情况非常普遍，尽管先前的研究表明，阿奇霉素可能与心血管事件风险增加有关。
方法和结果 本研究使用了来自 ISACS-COVID-19（国际急性冠状病毒综合征-COVID-19 调查）登记处的数据。符合 SARS-CoV-2 感染确诊诊断的患者有资格入组。该研究纳入了 793 例在入院后 24 小时内接受阿奇霉素治疗的患者和 2141 例仅接受标准治疗的患者。主要暴露因素是心血管疾病（CVD）。主要结局指标是 30 天死亡率和急性心力衰竭（AHF）。在 2934 例患者中，有 1066 例（36.4%）患有预先存在的 CVD。共有 617 例（21.0%）死亡，253 例（8.6%）发生 AHF。在患有预先存在的 CVD 的患者中，阿奇霉素治疗与 AHF 的风险增加始终相关（风险比 [RR]，1.48 [95%CI，1.06-2.06]）。与接受标准治疗相比，接受阿奇霉素治疗与死亡无显著相关性（RR，0.94 [95%CI，0.69-1.28]）。相比之下，我们发现预先没有 CVD 的患者的死亡几率显著降低（RR，0.57 [95%CI，0.42-0.79]），并且 AHF 没有显著增加（RR，1.23 [95%CI，0.75-2.04]）。这两个亚组的死亡相对风险差异具有统计学意义（=0.01）。AHF 与死亡之间存在显著的关联（比值比，2.28 [95%CI，1.34-3.90]）。
结论 这些发现表明，COVID-19 合并预先存在的 CVD 病史的患者使用阿奇霉素与 AHF 和 30 天全因死亡率增加显著相关。
