# Coronary artery calcification is associated with reduced survival in mechanically ventilated COVID-19 patients in the MaastrICCht cohort

## TL;DR

Higher coronary artery calcification is linked to worse one-year survival in mechanically ventilated COVID-19 patients.

## Contribution

This study shows that CAC is a significant predictor of one-year survival in ventilated COVID-19 patients.

## Key findings

- A 1-point increase in CAC score was associated with a 13% higher hazard of death.
- Patients in the highest CAC tertile had a 3.32 times higher mortality risk compared to the lowest tertile.
- After adjusting for risk factors, higher CAC scores were still significantly linked to worse survival.

## Abstract

In mechanically ventilated COVID-19 patients, a higher degree of coronary artery calcification (CAC) has been associated with increased severity of multi-organ failure. Furthermore, non-survivors showed worse development of multi-organ failure over time compared to survivors with COVID-19. Nevertheless, it remains unclear whether more CAC is associated with worse long-term survival. Therefore, we studied the association between CAC and one-year survival. In a prospective cohort of 241 mechanically ventilated patients who underwent chest CT scans for clinical evaluation of critical disease, CAC was scored using a semi-quantitative 12-point grading system. Cox proportional hazards analyses were used to investigate the association between CAC score (continuous and tertiles) and one-year survival in crude models and models adjusted for risk factors. In the crude model, a 1-point higher CAC score was associated with a higher hazard ratio (HR) (with 95% confidence interval (CI)) of 1.13 (95%CI: 1.08;1.19, p-value: <0.001). Compared to the lowest tertile (n = 85), a higher mortality was shown for the medium (n = 81) and the highest (n = 75) tertiles, HR 1.21 (95%CI: 0.73;2.02, p-value:0.443) and HR 3.32 (95%CI: 2.10;5.27, p-value:<0.001), respectively. After adjustment for age, sex and APACHE-II score, and comorbidities, a higher CAC score was associated with statistically significant worse one-year survival HR 2.07 (95% CI: 1.18–3.63, p-value:0.012). More coronary artery calcifications (CAC) are associated with worse one-year survival in patients on mechanical ventilation for severe COVID-19.