新冠肺炎危重症患者中既有心血管疾病与死亡和心血管结局的关系。
Relationship Between Preexisting Cardiovascular Disease and Death and Cardiovascular Outcomes in Critically Ill Patients With COVID-19.
机构信息
Division of Cardiology, Department of Medicine (A.V., E.A., T.C., M.P., P.O., K.P., P.B., I.K., E.M., K.E., S.S.H.), University of Michigan, Ann Arbor.
Department of Medicine (C.M., T.U.A., H.S., H.B.), University of Michigan, Ann Arbor.
出版信息
Circ Cardiovasc Qual Outcomes. 2022 Oct;15(10):e008942. doi: 10.1161/CIRCOUTCOMES.122.008942. Epub 2022 Oct 4.
BACKGROUND
Preexisting cardiovascular disease (CVD) is perceived as a risk factor for poor outcomes in patients with COVID-19. We sought to determine whether CVD is associated with in-hospital death and cardiovascular events in critically ill patients with COVID-19.
METHODS
This study used data from a multicenter cohort of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 68 centers across the United States from March 1 to July 1, 2020. The primary exposure was CVD, defined as preexisting coronary artery disease, congestive heart failure, or atrial fibrillation/flutter. Myocardial injury on intensive care unit admission defined as a troponin I or T level above the 99th percentile upper reference limit of normal was a secondary exposure. The primary outcome was 28-day in-hospital mortality. Secondary outcomes included cardiovascular events (cardiac arrest, new-onset arrhythmias, new-onset heart failure, myocarditis, pericarditis, or stroke) within 14 days.
RESULTS
Among 5133 patients (3231 male [62.9%]; mean age 61 years [SD, 15]), 1174 (22.9%) had preexisting CVD. A total of 1178 (34.6%) died, and 920 (17.9%) had a cardiovascular event. After adjusting for age, sex, race, body mass index, history of smoking, and comorbidities, preexisting CVD was associated with a 1.15 (95% CI, 0.98-1.34) higher odds of death. No independent association was observed between preexisting CVD and cardiovascular events. Myocardial injury on intensive care unit admission was associated with higher odds of death (adjusted odds ratio, 1.93 [95% CI, 1.61-2.31]) and cardiovascular events (adjusted odds ratio, 1.82 [95% CI, 1.47-2.24]), regardless of the presence of CVD.
CONCLUSIONS
CVD risk factors, rather than CVD itself, were the major contributors to outcomes in critically ill patients with COVID-19. The occurrence of myocardial injury, regardless of CVD, and its association with outcomes suggests it is likely due to multiorgan injury related to acute inflammation rather than exacerbation of preexisting CVD.
REGISTRATION
NCT04343898; https://clinicaltrials.gov/ct2/show/NCT04343898.
背景
预先存在的心血管疾病（CVD）被认为是 COVID-19 患者预后不良的危险因素。我们旨在确定 CVD 是否与 COVID-19 重症患者的住院内死亡和心血管事件相关。
方法
本研究使用了来自美国 68 个中心的一个多中心成年 COVID-19 患者队列的实验室确诊 COVID-19 数据，这些患者于 2020 年 3 月 1 日至 7 月 1 日入住重症监护病房。主要暴露因素为 CVD，定义为先前存在的冠状动脉疾病、充血性心力衰竭或心房颤动/扑动。重症监护病房入院时的心肌损伤定义为肌钙蛋白 I 或 T 水平高于正常 99 百分位上限，这是次要暴露因素。主要结局是 28 天住院内死亡率。次要结局包括 14 天内的心血管事件（心搏骤停、新发心律失常、新发心力衰竭、心肌炎、心包炎或中风）。
结果
在 5133 例患者（3231 例男性[62.9%]；平均年龄 61 岁[标准差，15]）中，1174 例（22.9%）患有预先存在的 CVD。共有 1178 例（34.6%）死亡，920 例（17.9%）发生心血管事件。在校正年龄、性别、种族、体重指数、吸烟史和合并症后，预先存在的 CVD 与死亡风险增加 1.15（95%CI，0.98-1.34）相关。预先存在的 CVD 与心血管事件之间没有独立的关联。重症监护病房入院时的心肌损伤与死亡风险增加（校正比值比，1.93[95%CI，1.61-2.31]）和心血管事件（校正比值比，1.82[95%CI，1.47-2.24]）相关，无论是否存在 CVD。
结论
COVID-19 重症患者的结局主要与 CVD 危险因素有关，而不是 CVD 本身。心肌损伤的发生，无论是否存在 CVD，及其与结局的关联表明，它可能是由急性炎症引起的多器官损伤而不是预先存在的 CVD 恶化引起的。
登记
NCT04343898；https://clinicaltrials.gov/ct2/show/NCT04343898。
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