A systematic review and meta-analysis on the prevalence and impact of coronary artery disease in hospitalized COVID-19 patients

Background: COVID-19 accounts for more than half a billion deaths globally. The clinical mani-festations may vary in due course. Despite several studies aimed at determining the extent to which the disease's severity and mortality remain high when combined with other comorbidities, more research is required. Therefore, this review aimed to measure the pooled prevalence of coronary artery disease (CAD) among COVID-19 patients, specifically those with a history of CAD. Additionally, we aim to assess the association between mortality due to CAD and the severity of COVID-19 among hospitalized patients.Method: A comprehensive search in PubMed, Web of Science, the Cochrane Library, and the WHO COVID-19 database was conducted. English studies with original data on CAD, mortality, and ARDS among COVID-19 patients were included. PRISMA guidelines were followed.Results: Among the 2007 identified articles, 76 studies met the inclusion criteria. The pooled prevalence of CAD among COVID-19 patients was 14.4%(95% CI: 12.7-16.2). The highest prevalence was observed in European studies at 18.2%(95% CI: 13.3-24.2), while the lowest was in Asian studies at 10.4% (95% CI: 6.4-16.3). Participants with concurrent CAD at the time of hospital admission had twice the odds of mortality due to COVID-19 (2.64 [95% CI: 2.30-3.04]) with moderate heterogeneity (I2 = 45%, p < 0.01). Hospitalized COVID-19 patients with CAD had a 50% higher risk of ARDS (95% CI: 0.62-3.66), but this difference was not statistically significant.Conclusion: Although our analysis revealed evidence for a relationship between concurrent CAD at the time of hospital admission and mortality from COVID-19, however, global variation in health infrastructure, limitations of data reporting, and the effects of emerging variants must be considered in future investigations.

Automated summary

This review found that COVID-19 patients with concurrent coronary artery disease (CAD) have a higher risk of mortality. The prevalence of CAD varies among different regions, with the highest prevalence in Europe and the lowest in Asia. Hospitalized COVID-19 patients with CAD also have an increased risk of ARDS, although this difference is not statistically significant.