Background: In addition to the lungs, the coronavirus disease 2019 (COVID-19) also affects multiple organs throughout the body. The relationship between COVID-19 infection and cardiovascular disease, and the mechanisms by which this disease causes damage to the cardiovascular system are unclear. Coronary heart disease (CHD) is one of the common comorbidities of COVID-19, but there is insufficient evidence for its clinical features and impact on clinical outcomes. The aim of this study was to analyze the clinical characteristics of COVID-19 patients with comorbid CHD and the possible risk factors for the occurrence of critical illness.
Methods: A single-center, retrospective study was conducted to analyze COVID-19 patients admitted to the Sino-French New City Campus of Tongji Hospital in Wuhan, Hubei Province and treated by the Peking University National Medical Assistance Team between January 29 and March 10, 2020. Patients testing positive for SARS-CoV-2 viral nucleic acid in nasopharyngeal swab specimens and who had comorbid CHD, were included in the study. Clinical data and laboratory test results of eligible patients were collected, and the factors associated with the occurrence of critical illness among these patients were evaluated.
Results: A total of 205 patients were enrolled in this study, including 20 CHD patients and 185 non-CHD patients. The mean age was 66.7 years. Compared to non-CHD patients, more CHD patients had comorbid hypertension and diabetes (P < 0.05). In terms of laboratory tests, the CHD group did not differ significantly from the non-CHD group in blood routine, blood chemistry, and various inflammatory cytokines. More CHD patients experienced myocardial injury (25% vs 8.1% P < 0.031) and CHD patients were more likely to progress to critical illness (40% vs 16.8%P = 0.012). Univariate logistic regression analysis indicated that a history of CHD, occurrence of myocardial injury, high white blood cell (WBC) count, low lymphocyte count, and elevated levels of Cr, ferritin, IL-2R, IL-8 at admission were factors associated with the occurrence of critical illness. Multivariate regression analysis found that a history of CHD（OR=3.529, 95% CI =1.032-12.075, P =0.044），high WBC count（OR=1.289, 95% CI =1.136-1.463, P＜0.001） and low lymphocyte count（OR=0.215, 95% CI =0.075-0.616, P =0.004）were independent factors for the occurrence of critical illness among COVID-19 patients.
Conclusion: COVID-19 patients with comorbid CHD commonly exhibited myocardial injury and were prone to developing critical illness. Among COVID-19 patients, a history of CHD，high WBC count and low lymphocyte count were independent risk factors for the occurrence of critical illness. Greater attention and vigilance are needed in this regard during clinical practice.