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DOI: 10.1055/a-2583-0235
Heart

Prognostic value of CT-defined coronary sclerosis in COVID-19: results of a multicenter study based on the 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
› Further Information
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Abstract

Aims

Coronary calcification, as defined by computed tomography (CT), can be quantified with a score (CAC score). It is an established prognostic and predictive imaging marker of the cardiovascular risk profile. The prognostic relevance of the CAC score has been demonstrated for acute diseases, including the coronavirus disease 2019 (COVID-19) in preliminary studies. The aim of the present study was to prove the prognostic relevance of the CAC score in patients with coronavirus disease 2019.

Materials and Methods

The present study used a nationwide radiological research platform to conduct a multicenter retrospective study. The study included a total of 541 patients, 176 of whom were female (32.5%). The mean age of the patients was 61.2 years ± 15.6 years. The coronavirus (SARS-COV-2) disease was confirmed in all patients by PCR testing. The CAC score was calculated using the Weston score, which is a semiquantitative method. The primary outcome of the study was 30-day mortality.

Results

The overall mortality rate within the 30-day period was 21.2%, with 115 patients dying. The mean Weston score was 3.0 ± 3.6. 128 patients (23.7%) exhibited no evidence of coronary calcifications, as indicated by a Weston Score of 0. In the univariable regression analysis, the presence of calcifications was found to be associated with mortality, with an odds ratio of 1.68 (95% confidence interval 1.08–2.59, p=0.01). However, this result did not remain statistically significant in the multivariable analysis (p=0.49). The Weston score was found to be associated with mortality in the univariable analysis, with an odds ratio (OR) of 1.10 (95% CI 1.04–1.14, p < 0.001), and in the multivariable analysis, with an OR of 1.06 (95% CI 1.005–1.138, p = 0.036).

Conclusion

The imaging marker CAC score has been demonstrated to have a significant prognostic impact on 30-day mortality in patients diagnosed with coronavirus disease 2019 (COVID-19). It is incumbent upon the radiologist to acknowledge the sole presence of coronary calcifications as a relevant prognostic factor. The prognostic relevance of the calcifications was found to be greater in cases where more extensive calcification was present.

Key Points

  • Coronary calcifications assessed by CT are prognostic markers for 30-day COVID-19 mortality.

  • Calcification extent has greater prognostic value than the mere presence of calcifications.

  • The study highlights the need to integrate coronary calcifications into clinical risk scores.

Citation Format

  • 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

Keywords

COVID-19 - computed tomography (CT) - coronary calcifications - prediction - imaging biomarker - infection

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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