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Vol 19 (2024): Continuous Publishing
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Published online: 2024-07-09

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Coronary artery calcium score predicts outcome in patients with COVID-19

Carl Thaddäus Braun1, Maximilian Zehnpfennig1, Konrad Szmyczyk2, Edyta Cwiek1, Jarosław Damian Kasprzak2, Piotr Lipiec1
DOI: 10.5603/fc.100542


Purpose. Coronary artery calcium (CAC) score is a proven prognostic cardiovascular risk marker. This study aims to evaluate the prognostic value of the CAC score on standard chest computed tomography (CT) in patients admitted with COVID-19.

Methods. We enrolled 144 consecutive patients (mean age 67± 13 years, 60.7% male) hospitalized with COVID-19. On admission, they underwent chest CT to detect and assess pulmonary involvement. Two investigators blinded to the patient's clinical data calculated the CAC score. Patients were followed up for an average of 14 months after their admission.

Results. 106 patients (mean age 66,5 ± 14 years, 66% male) had image quality sufficient for analysis. The median CAC score was 249 Agatston units (interquartile range 658). 33 deaths were recorded in the study group during the follow-up period. The median values of CAC of patients who died during the study period and of the survivors were 592 (interquartile range 1492) and 142 (interquartile range 400), respectively. The difference in CAC between these two subgroups was statistically significant (p = 0,0001). The area under the ROC curve for the CAC score for predicting all-cause mortality was 0.738 (95% CI 0,644 to 0,819). The criterion with the highest prognostic accuracy was CAC score > 143 Agatston units (positive and negative predictive values were 44,4% and 88,4%, respectively). The presence of this criterion was associated with a 3,9 times higher relative risk of mortality (95%CI 1.66 – 9,41; p = 0.0019).

Conclusion. CAC score measurement based on standard chest CT performed on admission in patients with COVID-19 to detect pulmonary involvement is a prognostic marker of increased mortality during the 14-month follow-up.

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