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DOI: 10.1055/a-2583-0235
Heart

Prognostische Bedeutung von CT-definierter Koronarsklerose bei COVID-19: Ergebnisse einer multizentrischen Studie basierend auf dem Weston-Score

Article in several languages: English | deutsch
Andreas Michael Bucher 
1   University Hospital, Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt Faculty 16 Medicine, Frankfurt am Main, Germany (Ringgold ID: RIN144867)
,
Eric Frodl
1   University Hospital, Institute for Diagnostic and Interventional Radiology, Goethe University Frankfurt Faculty 16 Medicine, Frankfurt am Main, Germany (Ringgold ID: RIN144867)
,
Constantin Ehrengut
2   Department of Radiology, University Hospital Leipzig, Leipzig, Germany (Ringgold ID: RIN39066)
,
Lukas Müller
3   Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
,
Tilman Emrich
3   Department for Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
,
Roman Kloeckner 
4   Department of Radiology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
,
Malte Sieren
4   Department of Radiology, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany
,
Marwin-Jonathan Sähn 
5   Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
,
Matthias A. Fink 
6   Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)
,
Dorottya Móré
6   Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Ringgold ID: RIN27178)
,
Bohdan Melekh
7   Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
,
Sebastian Gottschling
7   Department of Radiology and Nuclear Medicine, University Hospital of Magdeburg, Magdeburg, Germany
,
Felix Meinel 
8   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Hospital of Rostock, Rostock, Germany
,
Hanna Schön
8   Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Hospital of Rostock, Rostock, Germany
,
Norman Kornemann
9   Department of Radiology, Hannover Medical School, Hanover, Germany (Ringgold ID: RIN9177)
,
Diane Miriam Renz 
9   Department of Radiology, Hannover Medical School, Hanover, Germany (Ringgold ID: RIN9177)
,
Nora Lubina
10   Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
,
Claudia Wollny
10   Clinic for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
,
Matthias Stefan May 
11   Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
,
Lisa Siegler
11   Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
,
Jan Borggrefe
12   Institute of Radiology, Neuroradiology and Nuclear Medicine Minden, Ruhr-University-Bochum, Minden, Germany
,
Hans-Jonas Meyer
2   Department of Radiology, University Hospital Leipzig, Leipzig, Germany (Ringgold ID: RIN39066)
,
Alexey Surov
12   Institute of Radiology, Neuroradiology and Nuclear Medicine Minden, Ruhr-University-Bochum, Minden, Germany
› Author Affiliations

Supported by: This research was supported by the German Federal Ministry of Education and Research (BMBF) as part of the University Medicine Network Project RACOON, 01KX2021
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Zusammenfassung

Ziel

Die Quantifizierung der Koronarsklerose erfolgt mittels CAC-Score, welcher im Rahmen einer Computertomografie (CT) ermittelt wird. Der prognostische und prädiktive Wert dieses bildgebenden Markers für das kardiovaskuläre Risiko ist bereits etabliert. Die prognostische Relevanz bei akuten Erkrankungsbildern, einschließlich der Erkrankung durch das Virus SARS-COV-2, basiert auf vorläufigen Studienergebnissen. Die vorliegende Studie hatte zum Ziel, die prognostische Relevanz des CAC-Scores bei Patienten mit einer Diagnose von Coronavirus-Infektion (COVID-19) zu untersuchen.

Material und Methoden

Die Studie wurde auf einer deutschlandweiten radiologischen Forschungs-Plattform durchgeführt, wobei ein multizentrisches retrospektives Studiendesign zum Einsatz kam. In die Studie wurden insgesamt 541 Patienten (176 weiblich, 32,5%) eingeschlossen. Das mittlere Alter der Patientinnen und Patienten betrug 61,2 Jahre ± 15,6. Bei allen Patientinnen und Patienten war die Erkrankung durch das Coronavirus (SARS-COV-2) mittels PCR-Diagnostik gesichert. Die Bestimmung des CAC-Scores erfolgte semiquantitativ mittels Weston-Score. Die 30-Tage-Mortalität stellt den primären Endpunkt der Studie dar.

Ergebnisse

Insgesamt verstarben 115 Patienten, was einem Anteil von 21,2% entspricht, innerhalb des 30-Tageszeitraums. Der mittlere Weston-Score betrug 3,0 ± 3,6. Bei 128 Patienten (23,7%) konnten keine Verkalkungen der Koronarien festgestellt werden (Weston-Score von 0). Die univariablen Ergebnisse der Regressionsanalyse legen einen statistisch signifikanten Zusammenhang zwischen dem Vorhandensein von Verkalkungen und der Mortalität nahe. Das entsprechende Odds Ratio beträgt 1,68 (95%-Konfidenzintervall: 1,08–2,59; p = 0,01). In der multivariablen Analyse konnte dieser Zusammenhang jedoch nicht als statistisch signifikant nachgewiesen werden (p = 0,49). Die Analyse des Weston-Scores als metrische Variable ergab in der univariablen Analyse ein OR von 1,10 (95%-KI 1,04–1,14, p < 0,001) sowie in der multivariablen Analyse ein OR von 1,06 (95%-KI 1,005–1,138, p = 0,036).

Schlussfolgerung

Der bildgebende CAC-Score besitzt eine signifikante prognostische Relevanz hinsichtlich der 30-Tage-Mortalität bei Patienten, die an einer Coronavirus-Infektion (COVID-19) erkrankt sind. Es wird empfohlen, dass der Radiologe das alleinige Vorhandensein von Verkalkungen der Koronarien als wichtigen Parameter bei diesen Patienten berücksichtigt und beurteilt. Des Weiteren scheint das Ausmaß der Verkalkungen eine höhere prognostische Relevanz aufzuweisen.

Kernaussagen

  • CT-bewertete Koronarkalkablagerungen sind prognostische Marker für die 30-Tage-COVID-19-Mortalität.

  • Das Ausmaß der Verkalkung hat größeren prognostischen Wert als deren bloßes Vorhandensein.

  • Die Studie unterstreicht die Notwendigkeit, koronare Verkalkungen in klinische Risikoscores zu integrieren.

Zitierweise

  • Bucher AM, Frodl E, Ehrengut C et al. Prognostic value of CT-defined coronary sclerosis in COVID-19: results of a multicenter study based on the Weston score. Rofo 2025; DOI 10.1055/a-2583-0235

Supplementary Material



Publication History

Received: 23 December 2024

Accepted after revision: 31 March 2025

Article published online:
26 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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