nach oben

Erschienen in:

25.07.2023 | EM - ORIGINAL

Assessing risk of major adverse cardiac event among COVID-19 patients using HEART score

verfasst von: Afrah Abdul Wahid Ali, Quincy Tran, Neeraja Murali, Benoit Stryckman, Daniel Lemkin, Mark Sutherland, Zachary Dezman

Erschienen in: Internal and Emergency Medicine | Ausgabe 8/2023

Einloggen, um Zugang zu erhalten

Abstract

Coronavirus disease 2019 (COVID-19) is known to be associated with cardiovascular complications, but whether the current validated HEART score for chest pain is still applicable for these patients is unknown. This study aims to identify the impact and association of COVID-19 co-infection in patients presenting with chest pain and a calculated HEART score to the emergency departments (ED) with 30-day of major adverse cardiac event (MACE). This is a multicenter, retrospective observational study that included adult (age ≥ 18 years) patients visiting 13 different EDs with chest pain and evaluated using a HEART score. The primary outcome was the percentage of 30-day MACE, which included acute myocardial infarction, emergency percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or death among patients who presented with chest pain and had COVID-19 co-infection. The sensitivity and specificity of the HEART score among COVID-19 co-infection for MACE were assessed by the receiver operating curve (ROC). We analyzed records of 46,210 eligible patients, in which 327 (0.7%) patients were identified as infected with COVID-19. Patients with COVID-19 had higher mean total HEART score of 3.3 (1.7), compared to patients who did not have COVID-19 (3.1, SD 1.8, P = 0.048). The rate of MACE was similar between both groups. There were only 2 (0.6%) COVID-19 patients who had MACE, compared to 504 (1.1%) patients in control group. Total HEART score was associated with an area under the ROC (AUROC) of 0.99, while the control group’s was 0.78. History was associated with high AUROC in both COVID-19 (0.74) and control groups (0.76). Older age in COVID-19 had higher AUROC (0.89) than control patients (0.63). Among patients presenting to the ED with chest pain and having COVID-19 infection, HEART score had predictive capability for MACE, similar to patients without COVID-19 infection. Further studies with more COVID-19 patients are still necessary to confirm our observation.

World Health Organization. Coronavirus disease 2019 (COVID‐19): Situation report—70. 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200330-sitrep-70-covid-19.pdf?sfvrsn=7e0fe3f8_4. Accessed 1 March 2022

Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y (2020) The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 55(5):105955. https://doi.org/10.1016/j.ijantimicag.2020.105955CrossRefPubMedPubMedCentral

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W (2020) China novel coronavirus investigating and research team a novel coronavirus from patients with pneumonia in China. N Engl J Med 382(8):727–733. https://doi.org/10.1056/NEJMoa2001017CrossRefPubMedPubMedCentral

John Hopkins University: Coronavirus Resource Center. COVID-19 Dashboard. https://coronavirus.jhu.edu/map.html. Accessed 1 March 2022

Centers for Disease Control and Prevention. COVID Data Tracker. Atlanta, GA: US Department of Health and Human Services, CDC; 2022, March 01. https://covid.cdc.gov/covid-data-tracker. Accessed 1 March 2022

Zheng YY, Ma YT, Zhang JY, Xie X (2020) COVID-19 and the cardiovascular system. Nat Rev Cardiol 17(5):259–260. https://doi.org/10.1038/s41569-020-0360-5CrossRefPubMedPubMedCentral

Ravindra K, Malik VS, Padhi BK, Goel S, Gupta M (2022) Asymptomatic infection and transmission of COVID-19 among clusters: systematic review and meta-analysis. Public Health 203:100–109. https://doi.org/10.1016/j.puhe.2021.12.003CrossRefPubMed

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223):497–506. https://doi.org/10.1016/S0140-6736(20)30183-5. (Erratum in: Lancet. 2020 Jan 30)CrossRefPubMedPubMedCentral

Wang D, Hu B, Hu C et al (2020) Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323(11):1061–1069. https://doi.org/10.1001/jama.2020.1585CrossRefPubMedPubMedCentral

10.

Farshidfar F, Koleini N, Ardehali H (2021) Cardiovascular complications of COVID-19. JCI Insight 6(13):e148980. https://doi.org/10.1172/jci.insight.148980CrossRefPubMedPubMedCentral

11.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, Wang H, Wan J, Wang X, Lu Z (2020) Cardiovascular Implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 5(7):811–818. https://doi.org/10.1001/jamacardio.2020.1017CrossRefPubMed

12.

Long B, Brady WJ, Koyfman A, Gottlieb M (2020) Cardiovascular complications in COVID-19. Am J Emerg Med 38(7):1504–1507. https://doi.org/10.1016/j.ajem.2020.04.048CrossRefPubMedPubMedCentral

13.

Puttegowda B, Shivashankarappa AB, Dutta S, Chikkamuniswamy R, Bhat P, Krishnan S, Nanjappa MC (2021) Patterns of cardiovascular diseases in COVID-19 patients admitted to tertiary cardiac care centre. Indian Heart J 73(6):682–686. https://doi.org/10.1016/j.ihj.2021.10.007CrossRefPubMedPubMedCentral

14.

Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, Schwartz A, Uriel N (2020) COVID-19 and cardiovascular disease. Circulation 141(20):1648–1655. https://doi.org/10.1161/CIRCULATIONAHA.120.046941CrossRefPubMed

15.

Manolis AS, Manolis AA, Manolis TA, Melita H (2021) COVID-19 and acute myocardial Injury and Infarction: related mechanisms and emerging challenges. J Cardiovasc Pharmacol Ther 26(5):399–414. https://doi.org/10.1177/10742484211011026CrossRefPubMed

16.

Gramegna M, Baldetti L, Beneduce A, Pannone L, Falasconi G, Calvo F, Pazzanese V, Sacchi S, Pagnesi M, Moroni F, Ajello S, Melisurgo G, Agricola E, Camici PG, Scandroglio AM, Landoni G, Ciceri F, Zangrillo A, Cappelletti AM (2020) ST-segment-elevation myocardial infarction during COVID-19 pandemic: insights from a regional public service healthcare hub. Circ Cardiovasc Interv 13(8):e009413. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009413CrossRefPubMed

17.

Hamadeh A, Aldujeli A, Briedis K, Tecson KM, Sanz-Sánchez J, Al Dujeili M, Al-Obeidi A, Diez JL, Žaliūnas R, Stoler RC, McCullough PA (2020) Characteristics and outcomes in patients presenting with COVID-19 and ST-segment elevation myocardial infarction. Am J Cardiol 131:1–6. https://doi.org/10.1016/j.amjcard.2020.06.063CrossRefPubMedPubMedCentral

18.

De Filippo O, D’Ascenzo F, Angelini F, Bocchino PP, Conrotto F, Saglietto A, Secco GG, Campo G, Gallone G, Verardi R, Gaido L, Iannaccone M, Galvani M, Ugo F, Barbero U, Infantino V, Olivotti L, Mennuni M, Gili S, Infusino F, De Ferrari GM (2020) Reduced rate of hospital admissions for acs during Covid-19 outbreak in Northern Italy. New Engl J Med 383(1):88–89. https://doi.org/10.1056/NEJMc2009166CrossRefPubMed

19.

Poldervaart JM, Reitsma JB, Backus BE, Koffijberg H, Veldkamp RF, Ten Haaf ME, Appelman Y, Mannaerts HFJ, van Dantzig JM, van den Heuvel M, El Farissi M, Rensing BJWM, Ernst NMSKJ, Dekker IMC, den Hartog FR, Oosterhof T, Lagerweij GR, Buijs EM, van Hessen MWJ, Landman MAJ, Hoes AW (2017) Effect of using the HEART score in patients with chest pain in the emergency department: a stepped-wedge, cluster randomized trial. Ann Internal Med 166(10):689–697. https://doi.org/10.7326/M16-1600CrossRef

20.

Backus BE, Six AJ, Kelder JC, Mast TP, van den Akker F, Mast EG, Monnink SH, van Tooren RM, Doevendans PA (2010) Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 9(3):164–169. https://doi.org/10.1097/HPC.0b013e3181ec36d8CrossRefPubMed

21.

Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA (2013) A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 168(3):2153–2158. https://doi.org/10.1016/j.ijcard.2013.01.255CrossRefPubMed

22.

Six AJ, Cullen L, Backus BE, Greenslade J, Parsonage W, Aldous S, Doevendans PA, Than M (2013) The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study. Crit Pathw Cardiol 12(3):121–126. https://doi.org/10.1097/HPC.0b013e31828b327eCrossRefPubMed

23.

Spiegel R, Sutherland M, Brown R, Honasoge A, Witting M (2021) Clinically relevant adverse cardiovascular events in intermediate heart score patients admitted to the hospital following a negative emergency department evaluation. Am J Emerg Med 46:469–475. https://doi.org/10.1016/j.ajem.2020.10.065CrossRefPubMed

24.

Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160CrossRefPubMed

25.

Tessitore E, Carballo D, Poncet A, Perrin N, Follonier C, Assouline B, Carballo S, Girardin F, Mach F (2021) Mortality and high risk of major adverse events in patients with COVID-19 and history of cardiovascular disease. Open heart 8(1):e001526. https://doi.org/10.1136/openhrt-2020-001526CrossRefPubMedPubMedCentral

26.

Sasson I (2021) Age and COVID-19 mortality: a comparison of Gompertz doubling time across countries and causes of death. Demogr Res 44:379CrossRef

27.

Onder G, Rezza G, Brusaferro S (2020) Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 323(18):1775–1776. https://doi.org/10.1001/jama.2020.4683CrossRefPubMed

28.

Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D (2020) Elevated troponin in patients with coronavirus disease 2019: possible mechanisms. J Cardiac Fail 26(6):470–475. https://doi.org/10.1016/j.cardfail.2020.04.009CrossRef

29.

Wibowo A, Pranata R, Akbar MR, Purnomowati A, Martha JW (2021) Prognostic performance of troponin in COVID-19: a diagnostic meta-analysis and meta-regression. Int J Infect Dis 105:312–318. https://doi.org/10.1016/j.ijid.2021.02.113CrossRefPubMedPubMedCentral

30.

Ammirati E, Lupi L, Palazzini M, Hendren NS, Grodin JL, Cannistraci CV, Schmidt M, Hekimian G, Peretto G, Bochaton T, Hayek A, Piriou N, Leonardi S, Guida S, Turco A, Sala S, Uribarri A, Van de Heyning CM, Mapelli M, Campodonico J, Metra M (2022) Prevalence, characteristics, and outcomes of COVID-19-associated acute myocarditis. Circulation 145(15):1123–1139. https://doi.org/10.1161/CIRCULATIONAHA.121.056817CrossRefPubMedPubMedCentral

31.

Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Lane DA, Lip GYH (2021) Prevalence and clinical outcomes of myocarditis and pericarditis in 718,365 COVID-19 patients. Eur J Clin Investig 51(11):e13679. https://doi.org/10.1111/eci.13679CrossRef

32.

Wong C, Mansoor A, McGinn T (2022) Fulminant and non-fulminant clinical COVID-19 myocarditis in the New York City area in 2020. Ann Glob Health 88(1):18. https://doi.org/10.5334/aogh.3583CrossRefPubMedPubMedCentral

33.

Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, Maharjan A, Gautam R (2021) D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PloS One 16(8):e0256744. https://doi.org/10.1371/journal.pone.0256744CrossRefPubMedPubMedCentral

34.

Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, Chen X, Chen S, Yu K, Huang Z, Hu B (2020) D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensiv Care 8:49. https://doi.org/10.1186/s40560-020-00466-zCrossRef

35.

García de Guadiana-Romualdo L, Morell-García D, Rodríguez-Fraga O, Morales-Indiano C, María Lourdes Padilla Jiménez A, Gutiérrez Revilla JI, Urrechaga E, Álamo JM, Hernando Holgado AM, Lorenzo-Lozano MDC, Sánchez Fdez-Pacheco S, de la Hera Cagigal P, Juncos Tobarra MÁ, Vílchez JA, Vírseda Chamorro I, Gutiérrez Garcia I, Pastor Murcia Y, Sahuquillo Frías L, Altimira Queral L, Nuez-Zaragoza E, Consuegra-Sánchez L (2021) Cardiac troponin and COVID-19 severity: results from BIOCOVID study. Eur J Clin Investig 51(6):e13532. https://doi.org/10.1111/eci.13532CrossRef

Titel: Assessing risk of major adverse cardiac event among COVID-19 patients using HEART score
verfasst von: Afrah Abdul Wahid Ali
Quincy Tran
Neeraja Murali
Benoit Stryckman
Daniel Lemkin
Mark Sutherland
Zachary Dezman
Publikationsdatum: 25.07.2023
Verlag: Springer International Publishing
Erschienen in: Internal and Emergency Medicine / Ausgabe 8/2023
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-023-03380-y

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

RAS-Blocker bei Hyperkaliämie möglichst nicht sofort absetzen

14.05.2024 Hyperkaliämie Nachrichten

Bei ausgeprägter Nierenfunktionsstörung steigen unter der Einnahme von Renin-Angiotensin-System(RAS)-Hemmstoffen nicht selten die Serumkaliumspiegel. Was in diesem Fall zu tun ist, erklärte Prof. Jürgen Floege beim diesjährigen Allgemeinmedizin-Update-Seminar.

Gestationsdiabetes: In der zweiten Schwangerschaft folgenreicher als in der ersten

13.05.2024 Gestationsdiabetes Nachrichten

Das Risiko, nach einem Gestationsdiabetes einen Typ-2-Diabetes zu entwickeln, hängt nicht nur von der Zahl, sondern auch von der Reihenfolge der betroffenen Schwangerschaften ab.

Labor, CT-Anthropometrie zeigen Risiko für Pankreaskrebs

13.05.2024 Pankreaskarzinom Nachrichten

Gerade bei aggressiven Malignomen wie dem duktalen Adenokarzinom des Pankreas könnte Früherkennung die Therapiechancen verbessern. Noch jedoch klafft hier eine Lücke. Ein Studienteam hat einen Weg gesucht, sie zu schließen.

Battle of Experts: Sport vs. Spritze bei Adipositas und Typ-2-Diabetes

11.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Im Battle of Experts traten zwei Experten auf dem Diabeteskongress gegeneinander an: Die eine vertrat die Auffassung „Sport statt Spritze“ bei Adipositas und Typ-2-Diabetes, der andere forderte „Spritze statt Sport!“ Am Ende waren sie sich aber einig: Die Kombination aus beidem erzielt die besten Ergebnisse.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Bildnachweise

Die Leitlinien für Ärztinnen und Ärzte, Ärztin führt eine Nierenultraschalluntersuchung durch/© Graphicroyalty / stock.adobe.com (Symbolbild mit Fotomodell), Schwangere misst Blutzucker/© MMPhotography / Getty Images / iStock (Symbolbild mit Fotomodell), Duktales Pankreaskarzinom/© Dörffel, Y., Wermke, W. / all rights reserved Springer Medizin Verlag GmbH, Füße einer adipösen Frau auf einem Laufband/© Idanupong / stock.adobe.com (Symbolbild mit Fotomodell)

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2023

Performance of an artificial intelligence-based chatbot when acting as EMS dispatcher in a cardiac arrest scenario

A rare presentation of heart failure with preserved ejection fraction

Comment on self-reported symptoms after COVID-19 vaccination

Emergency department crowding: an overview of reviews describing measures, causes and harms—comment

An unusual case of facial palsy in an immunocompetent adult woman