Relationship Between Preexisting Cardiovascular Disease and Death and Cardiovascular Outcomes in Critically Ill Patients With COVID-19.
Relationship Between Preexisting Cardiovascular Disease and Death and Cardiovascular Outcomes in Critically Ill Patients With COVID-19.
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DOI：
10.1161/circoutcomes.122.008942
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发表时间：
2022-10
影响因子：
6.9
通讯作者：
Hayek, Salim S.
中科院分区：
文献类型：
--
作者：
Vasbinder, Alexi;Meloche, Chelsea;Azam, Tariq U.;Anderson, Elizabeth;Catalan, Tonimarie;Shadid, Husam;Berlin, Hanna;Pan, Michael;O'Hayer, Patrick;Padalia, Kishan;Blakely, Pennelope;Khaleel, Ibrahim;Michaud, Erinleigh;Huang, Yiyuan;Zhao, Lili;Pop-Busui, Rodica;Gupta, Shruti;Eagle, Kim;Leaf, David E.;Hayek, Salim S.
既往心血管疾病被认为是新冠肺炎患者预后不良的危险因素。我们试图确定心血管疾病是否与新冠肺炎危重患者的院内死亡和心血管事件有关。这项研究使用了2020年3月1日至7月1日期间在全美68个中心的重症监护病房(ICU)接受实验室确诊的新冠肺炎患者的多中心队列数据。主要暴露于心血管疾病，定义为既有冠状动脉疾病、充血性心力衰竭或心房颤动/扑动。在ICU入院时，心肌损伤定义为肌钙蛋白I或T水平高于正常的第99百分位参考上限，为二次暴露。主要结果是28天的住院死亡率。次要结果包括14天内的心血管事件(心脏骤停、新发心律失常、新发心力衰竭、心肌炎、心包炎或中风)。在5,133名患者(3,231名男性[62.9%]；平均年龄61岁[标准差15])中，1,174名(22.9%)有既往心血管疾病。共有1178人(34.6%)死亡，920人(17.9%)有心血管事件。在调整了年龄、性别、种族、体重指数、吸烟史和合并症后，既往心血管疾病与1.15(95%CI：0.98-1.34)更高的死亡几率相关。未观察到先前存在的心血管疾病和心血管事件之间的独立关联。无论有无心血管疾病，ICU入院时心肌损伤与较高的死亡(调整后优势比[AOR]=1.93，95%可信区间[1.61~2.31])和心血管事件(调整后优势比=1.82，95%可信区间[1.47~2.24])相关。心血管危险因素，而不是心血管疾病本身，是影响新冠肺炎危重患者预后的主要因素。心肌损伤的发生与心血管疾病无关，其与预后的相关性表明，这可能是由于与急性炎症相关的多器官损伤，而不是先前存在的心血管疾病的恶化。NCT04343898；https://clinicaltrials.gov/ct2/show/NCT04343898
Pre-existing 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. This study used data from a multicenter cohort of adults with laboratory confirmed COVID-19 admitted to intensive care units (ICUs) at 68 centers across the United States from March 1-July 1, 2020. The primary exposure was CVD, defined as pre-existing coronary artery disease, congestive heart failure, or atrial fibrillation/flutter. Myocardial injury on ICU 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. Among 5,133 patients (3,231 male [62.9%]; mean age 61 years [standard deviation 15]), 1,174 (22.9%) had pre-existing CVD. A total of 1,178 (34.6%) died and 920 (17.9%) had a CV event. After adjusting for age, sex, race, body mass index, history of smoking, and comorbidities, pre-existing CVD was associated with a 1.15 (95% CI: 0.98–1.34) higher odds of death. No independent association was observed between pre-existing CVD and CV events. Myocardial injury on ICU admission was associated with higher odds of death (adjusted odds ratio [aOR]=1.93, 95%CI [1.61–2.31]) and CV events (aOR=1.82, 95%CI [1.47–2.24]), regardless of the presence of CVD. CVD risk factors, rather than CVD itself, were the major contributors of 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 multi-organ injury related to acute inflammation rather than exacerbation of preexisting CVD. NCT04343898; https://clinicaltrials.gov/ct2/show/NCT04343898
影响因子：
4.6
作者：
Mengozzi A;Georgiopoulos G;Falcone M;Tiseo G;Pugliese NR;Dimopoulos MA;Ghiadoni L;Barbieri G;Forfori F;Carrozzi L;Santini M;Monzani F;De Marco S;Menichetti F;Virdis A;Masi S;Pisa Covid Study Group
通讯作者：
Pisa Covid Study Group
影响因子：
1.1
作者：
Badawi A;Vasileva D
通讯作者：
Vasileva D