BACKGROUND Coronavirus disease 2019 (Covid-19) may disproportionately affect people with cardiovascular disease. Concern has been aroused regarding a potential harmful effect of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) in this clinical context. METHODS Using an observational database from 169 hospitals in Asia, Europe, and North America, we evaluated the relationship of cardiovascular disease and drug therapy with in-hospital death among hospitalized patients with Covid-19 who were admitted between December 20, 2019, and March 15, 2020, and were recorded in the Surgical Outcomes Collaborative registry as having either died in the hospital or survived to discharge as of March 28, 2020. RESULTS Of the 8910 patients with Covid-19 for whom discharge status was available at the time of the analysis, a total of 515 died in the hospital (5.8%) and 8395 survived to discharge. The factors we found to be independently associated with an increased risk of in-hospital death were an age greater than 65 years (mortality of 10.0%, vs. 4.9% among those ≤65 years of age; odds ratio, 1.93; 95% confidence interval [CI], 1.60 to 2.41), coronary artery disease (10.2%, vs. 5.2% among those without disease; odds ratio, 2.70; 95% CI, 2.08 to 3.51), heart failure (15.3%, vs. 5.6% among those without heart failure; odds ratio, 2.48; 95% CI, 1.62 to 3.79), cardiac arrhythmia (11.5%, vs. 5.6% among those without arrhythmia; odds ratio, 1.95; 95% CI, 1.33 to 2.86), chronic obstructive pulmonary disease (14.2%, vs. 5.6% among those without disease; odds ratio, 2.96; 95% CI, 2.00 to 4.40), and current smoking (9.4%, vs. 5.6% among former smokers or nonsmokers; odds ratio, 1.79; 95% CI, 1.29 to 2.47). No increased risk of in-hospital death was found to be associated with the use of ACE inhibitors (2.1% vs. 6.1%; odds ratio, 0.33; 95% CI, 0.20 to 0.54) or the use of ARBs (6.8% vs. 5.7%; odds ratio, 1.23; 95% CI, 0.87 to 1.74). CONCLUSIONS Our study confirmed previous observations suggesting that underlying cardiovascular disease is associated with an increased risk of in-hospital death among patients hospitalized with Covid-19. Our results did not confirm previous concerns regarding a potential harmful association of ACE inhibitors or ARBs with in-hospital death in this clinical context. (Funded by the William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women's Hospital.).

中文翻译：

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Covid-19 中的心血管疾病、药物治疗和死亡率。


背景 2019 年冠状病毒病 (Covid-19) 可能会对心血管疾病患者产生不成比例的影响。人们担心血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）在这种临床背景下的潜在有害作用。方法 使用来自亚洲、欧洲和北美 169 家医院的观察数据库，我们评估了 2019 年 12 月 20 日至 3 月期间入院的 Covid-19 住院患者的心血管疾病和药物治疗与院内死亡的关系。截至 2020 年 3 月 15 日，手术结果协作登记处记录为截至 2020 年 3 月 28 日在医院死亡或幸存出院。 结果 在 8910 名 Covid-19 患者中，截至 2020 年 3 月 28 日，其出院状态可用分析显示，共有515人在医院死亡（5.8%），8395人幸存出院。我们发现与院内死亡风险增加独立相关的因素是年龄大于 65 岁（死亡率为 10.0%，而 ≤65 岁的死亡率为 4.9%；优势比为 1.93；95% 置信度）间隔 [CI]，1.60 至 2.41）、冠状动脉疾病（10.2%，无疾病者为 5.2%；比值比，2.70；95% CI，2.08 至 3.51）、心力衰竭（15.3%，对比 5.6%）无心力衰竭患者中；比值比为 2.48；95% CI，1.62 至 3.79）；心律失常（11.5%，无心律失常患者中为 5.6%；比值比为 1.95；95% CI，1.33 至 2.86）阻塞性肺疾病（14.2%，无疾病者为 5.6%；比值比，2.96；95% CI，2.00 至 4.40），目前吸烟（9.4%，前吸烟者或不吸烟者为 5.6%；比值比， 1.79；95% CI，1.29 至 2.47）。 未发现院内死亡风险增加与使用 ACE 抑制剂（2.1% vs. 6.1%；比值比，0.33；95% CI，0.20 至 0.54）或使用 ARB（6.8% vs. 6.1%）相关。 5.7%；比值比，1.23；95% CI，0.87 至 1.74）。结论 我们的研究证实了之前的观察结果，即潜在的心血管疾病与 Covid-19 住院患者院内死亡风险增加有关。我们的结果并未证实之前关于 ACE 抑制剂或 ARB 与该临床背景下院内死亡之间潜在有害关联的担忧。 （由布莱根妇女医院高级心血管医学威廉·哈维杰出主席资助。）